Tuesday, February 27, 2018
ProPublica (Feb. 22, 2018): A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies, by Nina Martin:
The results of a five-year study, conducted by researchers in both the U.S. and Canada, on the effects of midwifery on maternal and infant health are in. The study was published in the peer-reviewed journal PLOS ONE; it analyzes hundreds of laws throughout the United States that dictate what a midwife can and cannot do when it comes to prenatal care and the birthing process.
'We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,' said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.
The midwife model emphasizes community-based maternal and infant care along with avoiding any unnecessary, and potentially dangerous, interventions. Midwives have long been widely embraced in Europe as a positive component of maternal care. In the U.S., though, midwives often represent a "culture war that encompasses gender, race, class, economic competition, professional and personal autonomy, risk versus safety, and philosophical differences."
The title "midwife" can have multiple meanings, ranging from "certified nurse-midwives," to "direct-entry midwives," to "lay midwives." Depending on the title and the state in which the midwife works, the midwife will have a different level of training and may or may not be licensed or regulated by the state.
This new study indicates, though, that midwives may be part of the answer to the U.S.'s problematic infant and maternal mortality rates. Severe maternal complications have sharply risen over the past 20 years, and maternal care is seriously sparse in certain areas of the country. "Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist."
While midwife regulations vary widely among states, the study shows that states that have more fully integrated midwifery systems within their health care have significantly better outcomes for mothers and babies. States with restrictive midwife regulations--like Alabama, Ohio, and Mississippi--regularly score much lower on tests of maternal and neonatal well-being.
Alabama, which has the worst infant mortality rate in the country, has long had strict midwife regulations, "reflecting attitudes that wiped out the state's once-rich tradition of black birth attendants." Alabama lawmakers, though, recently passed a bill legalizing certified professional midwives, taking one small step toward the process of greater midwife integration, and, hopefully, improved maternal and infant health care across racial and economic lines.
Access to midwifery is often split among racial lines, as many of the states with the worst outcomes (and higher levels of opposition to midwives), including Alabama, have large black populations. The study suggests a correlation between improved access to midwifery and reduced racial disparities in the maternal health care field.
Jennie Joseph, a British-trained midwife who runs the Florida birthing center and nonprofit Commonsense Childbirth affirms this:
“It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”
The study, though, does not conclude that better midwife access will directly lead to better outcomes or vice versa. It acknowledges that many other factors also affect maternal and infant health among states, including access to preventative care, insurance, and rates of chronic disease.
Nonetheless, maternal health advocates have long recognized the benefits of midwifery and this is not the only study to highlight the positive effects of supporting midwives. A 2014 study found that integrating midwives into health care could prevent more than 80 percent of maternal and infant fatalities worldwide, in both low and high-resource communities. Even in the U.S., organizations such as the American Congress of Obstetricians and Gynecologists have begun embracing nurse-midwives despite lingering skepticism by many.
Monday, February 26, 2018
Feb. 21, 2018 (Politico), State Department report will trim language on women's rights, discrimination, Nahal Toosi:
Each year the State Department issues an annual report on global human rights. This year, Politico reports that State Department officials have been ordered to cut down passages that discuss women's reproductive rights and discrimination.
The directive calls for stripping passages that describe societal views on family planning, including how much access women have to contraceptives and abortion.
A broader section that chronicles racial, ethnic and sexual discrimination has also been ordered pared down, . . . current and former [State Department] officials said.
Some career State Department officials have expressed concern that the changes could undermine the report’s impact and integrity. One State Department official said, "This sends a clear signal that women's reproductive rights are not a priority for this administration, and that it's not even a rights violation we must or should report on." A spokesperson for the State Department stated that any changes were made for focus and “clarity.”
Friday, February 23, 2018
Futurism (Feb. 2, 2018): Advanced Reproductive Technology is Here. But Who Decides Who Gets Access?, by Claudia Geib:
Reproductive technology has expanded and improved immensely over the years. The accessibility of assisted reproduction, fertility treatments, and even adoption, though, is highly limited, particularly in the United States. All of these processes can be prohibitively expensive, and, often, insurance does not cover them or organizations can arbitrarily choose not to provide them.
As reproductive technology is largely unregulated in the U.S., private organizations that manage processes such as embryo donations have full discretion when choosing who can participate in their programs. The National Embryo Donation Center (NEDC) states in its policies that they will only provide embryos to heterosexual, married couples, for example. The NEDC is founded in the Judeo-Christian worldview, and they explicitly exercise this viewpoint--or their perspective of it, at least--when selecting eligible couples for their services.
Jeffrey Keenan, the NEDC's medical director, says that their policy is to operate based on the "biological reality" of a family and God's intention for conception.
As much as you see gay people having children, you have noticed that none of them do it on their own. It is physically and scientifically impossible for gay people to have a child. So why just because we can have someone act as a surrogate, or because we can donate into a [gay] woman, why does that make it right? It doesn’t, not in and of itself.
Civil rights communities, LGBT groups, and, increasingly, the courts oppose these views. What many consider illegal discrimination, though, endures under the protection of U.S. law since such procedures are not generally considered "medically necessary."
Basic fertility treatments are rarely covered by U.S. insurance policies, and when they are, the insurance company may first require proof and documentation of a medical reason preventing "natural" pregnancy.
This is not the case in many other developed countries, where formal regulations, ethical requirements, and even entire administrative departments preside over reproductive technology. The United Kingdom's Human Fertilisation and Embryology Authority, for example, is solely committed to the regulation of fertility treatments and embryonic research in the U.K.
In the U.S., there is simply "no equality of access" to reproducing, says Antonio Gargiulo, an obstetrician-gynecologist and director of robotic surgery at the Brigham and Women's Hospital in Boston. As it stands, Boston residents do have access to fertility treatments under insurance, though; Massachusetts was the first state to pass laws requiring treatments be covered by insurance back in 1987. Just last year, New York also began requiring insurance companies to provide infertility treatments to those seeking, including homosexual couples and single women.
Many medical professionals, though, are skeptical that the federal government--particularly under the anti-regulation Trump administration--will make any moves toward ensuring fertility treatments and reproductive technology are uniformly covered by insurance and accessible to all Americans.
Thursday, February 22, 2018
The Baltimore Sun (Feb. 16, 2018): State employees left out of expanded contraception access under new Maryland law, by Meredith Cohn:
A new Maryland state law expanding access to contraception took effect on January 1, but the law surprisingly omits one group from the new benefits: state employees.
Maryland's Contraceptive Equity Act requires insurers to offer up to six months of contraceptive pills at one time with no copay, and also requires the provision of most other forms of birth control without cost, including Plan B, the over-the-counter morning-after pill. Women no longer need pre-authorization from their insurance provider for implants and IUDs. The law requires insurers to cover sterilization for men without charging out-of-pocket.
Now, Baltimore County Del. Shelly Hettleman has introduced legislation to fix the state employee loophole and ensure that almost 110,000 Maryland state employees can enjoy the new law's benefits. The Maryland Insurance Administration reports that the state is currently exempt because the new law only applies to state-regulated plans. Currently, the state government is mostly self-insured and only regulated by federal law.
According to the National Institute for Reproductive Health, about a dozen states have enacted laws ensuring access coverage of contraception.
Wednesday, February 21, 2018
ThinkProgress (Jan. 25, 2018): It’s now easier for trans people to update birth certificates in Russia than in many U.S. states, by Zack Ford:
Last month, Russia established new procedures to allow transgender persons to obtain gender-affirming medical documentation without undergoing surgery. Previously, the only way for a trans person to officially change their gender identity was through the submission of a "medical certificate on gender/sex change" to a civil registry office where individual civil servants would determine whether or not to change the applicant's listed identity. The Russian Ministry of Health signed the new order in January, and it went into effect on February 2, 2018.
Although Russia is regularly condemned for its anti-LGBTQ reputation, this new procedure is considered more progressive than those in the United States, which often require transgender patients to undergo surgery before their gender identity will be officially recognized.
The U.S. does not have uniform procedures on how to update gender on a birth certificate or other official documentation. "According to the Transgender Law Center...there are only 17 states that offer clear policies for changing birth certificates and do not require surgeries for recognition." 18 states have policies specifically mandating surgical requirements as a prerequisite to the paperwork. Governor Chris Christie twice vetoed bills in New Jersey that would have eliminated such requirements. The U.S. courts have so far produced inconsistent and unpredictable results for trans persons seeking policy changes.
Russia is not the only country making gender identity documentation more accessible. India and Nepal recognize transgender persons by issuing papers that identify them as a "third gender." Sweden, which practiced forced sterilization well into the 20th century, eliminated its surgical requirement for transgender people in 2013.
Gender reassignment surgery, meant to align a person's gender with their reproductive organs, often results in the patient losing their reproductive ability. Requiring surgery to recognize a trans person's gender is increasingly considered an unacceptable and illegal form of forced sterilization throughout the world. Furthermore, such procedures are often financially prohibitive, making gender alignment surgery, and thus--in the U.S. at least--obtaining legal documentation that recognizes one's gender, inaccessible.
Last year, the European Court of Human Rights ruled against surgical requirements in a French case. The Court cited Article VIII of the European Convention on Human Rights, which gives everyone the right to respect for "his private and family life."
Although Russia still faces intense discrimination against its LGBTQ community, Tatiana Glushkova of the Transgender Legal Defense Project is optimistic that the new procedures eliminating the need for surgery before trans persons can obtain proper medical certificates will “significantly improve the situation of trans people in Russia."
Friday, February 16, 2018
New York Times (Feb. 13, 2018): American Fertility Is Falling Short of What Women Want, by Lyman Stone:
Fertility rates in the United States have fallen below the replacement rate, and are beginning to diverge substantially from what women state as their reproductive goals. Whereas, women say they want on average 2.7 children, current rates show they will probably have no more than 1.8. That gap is the highest it has been in 40 years.
Explanations for the drop in fertility include postponing marriage, having less sex, and the decline in pregnancy rates among young women. That low rate now affects women throughout their 20s and early 30s. In the background is the fact that contraceptive technology has improved while reproductive technology has not.
Falling fertility rates might portend trouble for Social Security, a graying population in need of care, and stagnant economic growth.
Thursday, February 15, 2018
(Feb. 5, 2018) Maine's high court to decide if state, through MaineCare, must pay for abortions, by Eric Russell:
The Maine Supreme Court earlier this month agreed to take up a case filed by the ACLU of Maine in November 2015 on behalf of three providers – Mabel Wadsworth Center, Maine Family Planning and Planned Parenthood of Northern New England. The Court will decide whether the state's refusal to fund abortions for women on MaineCare, the state’s version of Medicaid, violates the Maine Constitution and state statute.
MaineCare currently covers pregnancy-related care if women choose to carry their pregnancy to term. The ACLU suit contends that because the state funds one kind of coverage for low-income women but doesn’t provide coverage for abortion care, it discriminates against women who decide to have an abortion and violates state equal protection.
Last fall, Maine's Superior Court ruled against the ACLU, arguing that there is no "basis in the Maine Constitution or a Maine statute for compelling the state to provide MaineCare funding" for abortion care, and that the ACLU should seek recourse in the legislature or executive branch. The ACLU appealed the decision, and the issue is now before the state's Supreme Court.
At the federal level, the Hyde Amendment bars federal funds from being used for abortions unless the pregnancy was a result of rape or incest or the abortion is necessary to save the life of the mother. Hyde does not bar states from providing coverage, though many states do restrict both public and private insurance coverage for abortion care, including Maine. Only four states voluntarily provide insurance coverage for abortion through state Medicaid programs. Thirteen more states are required to provide such coverage by court orders.
Wednesday, February 14, 2018
ProMedica Toledo Hospital authorizes patient-transfer agreement with Toledo, Ohio's last abortion clinic
Toledo Blade (Feb. 12, 2018): ProMedica authorizes patient-transfer agreement with Toledo's last abortion clinic, by Mark Reiter and David Patch:
Following a 5-2 Ohio Supreme Court ruling issued on February 6th ordering the closure of Toledo, Ohio's last abortion clinic for violating state law, the future of the clinic and of abortion access in northwest Ohio looked all too grim...until this past Monday the 12th.
After hours of protesting near ProMedica Toledo Hospital on Monday to call on ProMedica to enter into a patient-transfer agreement that would keep Capital Care Network, Toledo’s last abortion clinic, open, the hospital system’s board of trustees authorized the agreement.
In its decision ordering Capital Care Network to close, the Ohio Supreme Court cited that the clinic's hospital transfer agreement with the University of Michigan in Ann Arbor did not comply with the Ohio Department of Health's 30-minute transport time standard. The department had revoked Capital Care Network's license in 2014.
Following the enactment of a 2013 law requiring all abortion clinics in Ohio to maintain emergency patient-transfer agreements with local hospitals, Capital Care Network sued the state, arguing that the law presented an undue burden on abortion access in Ohio. While the lower courts sided with the clinic, the Ohio Supreme Court refused to tackle the state law's constitutional issues, instead finding that the state "had authority to revoke Capital Care's license based on the failure to comply with the administrative rule" promulgated by the Ohio Department of Health. Unless Capital Care Network could sign an agreement with a hospital within the 30-minute travel requirement, it would be forced to close.
Capital Care previously maintained an agreement with the University of Toledo Medical Center until 2013, when the hospital opted not to renew it. The Ohio legislature then prohibited publicly funded universities from providing transfer agreements to abortion clinics.
In its statement announcing the new agreement with Capital Care, ProMedica spokesperson Tedra White wrote, “entering into this agreement aligns with ProMedica’s mission and values, including our focus on being a health system dedicated to the well-being of northwest Ohio and our belief that no one is beyond the reach of life-saving health care.” “Furthermore," she wrote, "we believe that all individuals should have access to the best care in their neighborhoods.”
Jennifer Branch, an attorney representing Capital Care, said that once she obtains a copy of the transfer agreement, she will file documents with the Ohio Department of Health to halt license-revocation proceedings against the clinic.
Ohio has endured a wave of new laws restricting access to abortion care across the state over the past few years. Under Governor John Kasich, the number of abortion clinics in Ohio has dropped from sixteen to eight. Three are in the Cleveland-Akron area, two in Columbus, and one each in Toledo, Dayton, and Cincinnati. For now, thanks to ProMedica, the number will stand at eight.
Tuesday, February 13, 2018
Cosmopolitan (Feb. 6, 2018): Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018, by Jennifer Gerson Uffalussy:
A safe, early-pregnancy abortion option has been making waves across the United States since Planned Parenthood began its telemedicine abortion pilot program in Iowa in 2008.
Telemedicine abortions enable those seeking a pregnancy termination to meet with a nurse in a local clinic where both patient and nurse loop in an abortion-providing doctor via video chat. The doctor consults with the patient to determine that they are a good candidate for early pregnancy termination and then authorizes the nurse to dispense two small pills to the patient. The patient takes the first pill in the office in the presence of the nurse and doctor and then later takes the second pill at home. The pregnancy is terminated within a day or two.
These medications have become known at "the abortion pill" and include both mifepristone and misoprostol, which work together first to block the hormones a woman's body needs to sustain a pregnancy and then to empty her uterus. The FDA-approved abortion pills are for ending pregnancies less than 10 weeks along. A study of Planned Parenthood's telemedicine pilot program found that access to telemedicine abortions decreased second-trimester abortions throughout the state. Second-term abortions require surgical procedures and can carry increased risks.
Although abortion is legal in all 50 states, many states have tightened their restrictions on abortion access, making it very difficult for a person facing an unwanted pregnancy to safely terminate it. Restrictions such as mandatory waiting periods and insurance limitations are compounded in states with very few clinics that can perform abortions. In fact, about 90% of counties in the U.S. do not have an abortion provider.
Telemedicine allows a patient to meet with an abortion provider even if she doesn’t live near one. Instead of driving long distances, women can go to a closer clinic or Planned Parenthood and video-chat a live, somewhere-in-state abortion provider who prescribes and (virtually, via on-site clinic staff) hands over the meds. “There is no increased risk of complications with a telemedicine visit,” says Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. He led a groundbreaking study published last fall that found telemedicine abortions are just as safe as those in which a woman swallows mifepristone in the same room as a physician.
While mifepristone has so far demonstrated a highly-safe success rate (its rates of complications are fewer than most common pain relievers), it cannot be obtained over-the-counter; instead a clinic, hospital, or doctor's office must dispense it.
Some states will allow a pregnant person to video chat with a doctor from her home and then receive both pills in the mail. Since 2008, though, 19 states have challenged the expansion of telemedicine abortions by passing laws that specifically require mifepristone to be dispensed "in the physical presence of the prescribing clinician."
Planned Parenthood continues to expand its telemedicine program despite the challenges. It has now established 24 telemedicine locations in the nation and plans to add at least 10 additional locations--some in new states--throughout this year.
To find out if telemedicine abortion is available in your area, call the national Planned Parenthood hotline at 800-230-PLAN.
February 13, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Media, Medical News, Politics, Pregnancy & Childbirth, Pro-Choice Movement, Reproductive Health & Safety | Permalink | Comments (0)
Monday, February 12, 2018
CUNY Law's Human Rights and Gender Justice Clinic Co-Hosting Symposium on Poverty and Women in the U.S.
On February 27, 2018, the Center for Reproductive Rights, CUNY Law's Human Rights and Gender Justice Clinic, NYU Law, and others will host a symposium titled "American Poverty and Gender: Government Control and Neglect of Women Living in Poverty."
After an opening keynote from Dr. Khiara Bridges, author of The Poverty of Privacy Rights, a panel of experts will address issues ranging from reproductive justice and maternal health to criminalization and its impact on women.
The moderated discussion follows the December 2017 fact-finding mission to the United States by Professor Philip Alston, UN Special Rapporteur on extreme poverty and human rights. This forum aims to address the particular ways poverty affects women in the United States from an intersectional perspective considering gender, poverty, and race.
"American Poverty and Gender" is free and open to the public. It it will take place at NYU's Vanderbilt Hall on Tuesday, February 27, 2018 from 6:00 PM - 8:00 PM.
Wednesday, February 7, 2018
Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith
Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.
With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."
Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important. When it is absent, patients report both physical and psychological trauma.
Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."
This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.
The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity.
Saturday, February 3, 2018
Washington Post (January 31, 2018): Millennials have a surprising view on later-term abortions, by Eugene Scott:
This past Monday, the United States Senate voted to block a proposed 20-week ban on abortion care approved by the House of Representatives. A Quinnipiac poll from January 2017, however, may reveal the unpopularity of later-term abortion with millennial voters. At the very least, Scott posits, the controversy around later-term abortion will continue into the next generation.
The poll found that 49 percent of respondents ages 18 to 34 would support a ban on abortions after 20 weeks of pregnancy. Only individuals aged 35 to 49 responded more favorably to a proposed ban. The survey found that 35 percent of millennials think abortion should be legal in all cases, while 9 percent of millennials think abortion should be illegal in all cases.
The Senate voted 51 to 46 on a procedural hurdle, falling short of the 60 votes needed. Democratic senators like Angus King (I-ME) explained that more than 99% of abortions in the United States take place before 20 weeks, and that the proposed ban is "a solution in search of a problem."
Young anti-choice activists hope that an opposition to later-term abortion care will resonate with a wide swath of young voters. Maria, Lebron, a 19-year old student at Catholic University, hopes to shift the anti-choice movement away from its religious and political affiliations to a movement that emphasizes standing for "the baby" and for "the mother." "It cannot only be focused on the unborn," Lebron says.
The culture battle over abortion isn't over, Scott argues, and 45 years after Roe v. Wade, millennials show little sign of resolving the issue.
Friday, February 2, 2018
New York Times (Jan. 29, 2017): Ireland to Hold Abortion Referendum by the End of May, by Ed O'Loughlin:
The Irish government will hold a referendum at the end of May to consider repealing a constitutional provision that has resulted in an almost complete ban on abortion. The 8th Amendment to the Irish Constitution requires that authorities defend equally "the right to life of the unborn" and the "equal right to life of the mother." The provision has been interpreted to only allow abortion when a woman's life is in danger. The referendum will ask voters if they want to keep the 8th Amendment or repeal it allowing the legislature to pass legislation that would allow women access to abortion in a broader set of circumstances.
Prime Minister Leo Varadkar  confirmed that the minister of health is preparing legislation to allow unrestricted access to abortion up to the 12th week of pregnancy, and later in cases of rape, incest or fatal abnormality. That legislation, which echoes recommendations delivered by an all-party parliamentary committee last month, will be put before Parliament if the country votes to repeal the constitutional ban.
The U.N. Human Rights Committee has criticized Ireland's current abortion laws finding that they discriminate against women and can result in cruel and degrading treatment. Because of the abortion ban, 3,265 women traveled to the U.K. for abortions in 2016. The Prime Minister also noted that over 2,000 women and girls take pills to self-induce abortion each year and that the current laws prevent them from obtaining medical supervision or assistance if needed.