Category Archives: Female Reproductive System

Women’s health — Week 32: Menopause

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tacuin womenMenopause is a normal part of a woman’s life. It is the time of your last period, but symptoms can begin several years earlier, a time called perimenopause.

Some symptoms of menopause can last for months or years after you stop having periods. Continue reading

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Health law provides no guarantees of access to midwives, birthing centers

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PregnancyBy Michelle Andrews
KHN

Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extendingsuch coverage to plans where it used to be rare.

But for women who are interested in services provided by midwives and birthing centers, there are no coverage guarantees, despite the law’s provisions that prohibit insurers from discriminating against licensed medical providers.

Most women give birth in hospitals and are attended by obstetricians, but a growing number choose to deliver their babies at birth centers.

The centers, typically staffed by midwives, offer women who are at low risk for complications an alternative to traditional hospital labor and delivery, eschewing common medical interventions such as drugs to induce labor and electronic fetal monitors, among other things. Continue reading

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Pharmacy staff frequently misinform teens seeking emergency contraception

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planb-thumbBy Katherine Kahn, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

Despite the fact that emergency contraception, also known as the morning-after pill, has been available since 2003, many teens still face barriers to obtaining the medication, a safe and effective way to prevent up to 74 percent of pregnancies following the failure of birth control or after unprotected sex.

A new study in the Journal of Adolescent Health finds that pharmacy staff frequently give teens misleading or incorrect information about emergency contraception that may prevent them from getting the medication.

“I was having lots of teenagers telling me weird things about emergency contraception prescriptions,” says lead study author Tracey Wilkinson, M.D., a pediatrician at the Children’s Hospital of Los Angeles.

She says that pharmacies might refuse to fill a prescription, confiscate a written prescription or even deny that an electronic prescription had been sent.

This led Wilkinson to investigate just what was happening at pharmacies when teens tried to purchase emergency contraception. Female researchers, posing as 17-year-old teens, called over 940 pharmacies in Nashville, Philadelphia, Cleveland, Austin, and Portland, Oregon and asked pharmacy staff basic questions about emergency contraception, including its availability, age requirements and confidentiality.

At the time of the study, the emergency contraception brand Plan B One Step was legally available to any person 17 years of age or older without a prescription, but was kept behind the pharmacy counter for purchase with a photo ID.

Other brands of emergency contraception, including a generic form, were available by prescription for all teens and women.

“About 20 percent of the pharmacy staff said that, because the callers identified themselves as teens, the callers couldn’t get [emergency contraception] at all. That’s completely incorrect,” says Wilkinson. “Of the remaining 80 percent of respondents, about half of them got the exact age requirement correct and half of them did not.”

Additionally, the study found that pharmacy staff often cited ethical reasons, such as institutional policies and personal religious beliefs, for not stocking or dispensing emergency contraception.

Pharmacy staff often inaccurately told callers a parent or legal guardian would need to accompany the teen to pick up the medication, or that an older friend or boyfriend couldn’t buy the prescription for them.

The federal laws governing the dispensing of emergency contraception have changed since the study was published—and have become even more confusing, says Wilkinson. As of July 2013, Plan B One Step is now legally available over the counter to anyone of any age, and no photo ID is necessary.

Other brands are either available to teens 17 or older at the pharmacy counter without a prescription, or to teens of any age with a prescription. One brand is available only by prescription, regardless of age.

Cora Collette Breuner, M.D., a pediatrician and member of the Committee for Adolescents of the American Academy of Pediatrics says, “Every time I go into a pharmacy, I see if Plan B is there without age restriction. And half of the time—or maybe even 80 percent of the time—it’s not. That’s against the law.”

Breuner says that one of the best ways for teens to avoid problems at pharmacies is to get an advance prescription for the generic form of emergency contraception from their pediatrician or clinic and get it filled.

Wilkinson echoes this advice: “I try to emphasize that teens should have emergency contraception at home, just like they have Tylenol for a headache—don’t wait until you need it to try and go get it.”

<strong><em><a title=”HBNS” href=”http://www.cfah.org/hbns/index.cfm” target=”_blank”>Health Behavior News Service</a> is part of the </em></strong><strong><em><a title=”Center for Advancing Health” href=”http://www.cfah.org/index.cfm” target=”_blank”>Center for Advancing Health</a></em></strong></p>
<strong>The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.</strong>

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Growth of Catholic hospitals — by the numbers

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by Nina Martin
ProPublica

The past few years have been a period of unprecedented turmoil for the hospital industry.Now, a new report confirms that Catholic hospitals are emerging as one of the few clear winners — and the study adds its voice to a growing chorus of warnings about how church doctrine could affect women’s reproductive health care.

The report is by MergerWatch, a New York–based nonprofit that tracks hospital consolidations, and the American Civil Liberties Union. It traces the growth of Catholic hospitals across the U.S. from 2001 to 2011, the most recent year for which complete data is available.

It focuses on full-service, acute-care hospitals with emergency rooms and maternity units —settings in which Catholic religious teachings are most likely to come into conflict with otherwise accepted standards of reproductive care.

The report’s major finding is illustrated in the chart below: At a time when other types of nonprofit hospitals have been disappearing, the number of Catholic-sponsored hospitals has jumped 16 percent.

Over the last decade, only for-profit hospitals have fared better. The gains by Catholic providers are especially striking considering the sharp decline in the number of other religious-owned hospitals during the same period.

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Source: MergerWatch

The numbers reflect the huge wave of hospital consolidations triggered by health care reform. For reasons that the report doesn’t delve into, Catholic hospitals have weathered those market upheavals better than other types of community hospitals—so well that they now make up 10 of the 25 largest health-care networks in the U.S.

Not surprisingly, the number of hospital beds at Catholic providers has also increased faster than at other types of nonprofit hospitals.

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Source: MergerWatch

According to the report, Catholic acute-care hospitals now account for 1 in 9 hospital beds around the country, with much higher concentrations in some states, including Washington (the subject of this ProPublica story), Wisconsin, and Iowa.

(When other types of facilities are included, the Catholic share of hospital beds is closer to 1 in 6, according to this fact sheet.)

Keep in mind that these numbers are from 2011. Since then, according to the report, the largest Catholic health hospital networks, Ascension Health and Catholic Health Initiatives, have grown by another 30 percent or more.

“The trend we’ve identified is continuing and perhaps even accelerating,” Lois Uttley, MergerWatch’s director, said in an interview. “These large Catholic health systems are expanding aggressively, taking over other hospitals and smaller health systems, gobbling up non-Catholic hospitals, and gaining more financial power.”

However, the report’s immediate concern isn’t the hospitals’ economic clout, but rather the impact of Catholic health care policy, as embodied by controversial guidelines known as The Ethical and Religious Directives.

Issued by the U.S. Conference of Catholic Bishops, the ERDs govern medical care at all Catholic hospitals — and influence care at secular hospitals that merge or affiliate with Catholic providers.

The directives ban elective abortion, sterilization, and birth control and restrict fertility treatments, genetic testing, and end-of-life options.

Depending on the hospital and the local bishop, they may also be interpreted to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and even the ability of doctors and nurses to discuss treatment options or make referrals.

A spokesman for the Catholic Health Association of the United States said he had not seen the report and could not comment. But in a statement responding to  a recent New York Times editorial, the association provided a spirited defense of its member hospitals.

“Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care …There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”

But Louise Melling, the ACLU’s deputy legal director and a coauthor of the new study, sees danger as Catholic hospitals expand their market share and the ERDs extend their reach as well.

She cites the case of a Michigan woman who was allegedly denied proper care for a miscarriage at a Catholic hospital in Muskegon because of its interpretation of the directives banning abortion.

In that case — the centerpiece of a high-profile lawsuit by the ACLU against the Catholic bishops last month — the hospital in question had been secular until 2008, when it was merged with a Catholic health care system.

“Ordinary people are not following hospital mergers and acquisitions,” Uttley said. “They don’t know who runs their hospital, especially if it doesn’t have a Catholic name. Even if it does have a Catholic name, people don’t know what that means.”

Archbishop Joseph Kurtz of Louisville, Ky., the newly elected president of the bishops conference, has called the lawsuit “baseless” and “misguided.” “A robust Catholic presence in health care helps build a society where medical providers show a fierce devotion to the life and health of each patient, including those most marginalized and in need,” he said.

The authors of the new report, titled “Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” assert that the risk to patients is especially great in areas where a Catholic hospital is the sole provider for an entire region.

The report also looks at how much money Catholic hospitals take in from Medicare and Medicaid—a total of $115 billion in gross patient revenues in 2011 — and urges the federal government to enforce laws that protect patients under those programs. (Back in 1999, when MergerWatch issued its first report on the role of religion in health care, the total billed by all religious hospitals — not just Catholic-sponsored ones—was $41 billion.)

One of the more surprising findings is the slightly below-average amount of charity care provided by Catholic acute-care facilities. The numbers are based on Medicare Cost Reports, financial and utilization data filed annually by every hospital, the report said.

ProPublica requested comment from the Catholic Health Association, and we’ll post it if it comes.

But the shift, if true, is a big change from the past, when Catholic hospitals were founded by nuns and brothers to minister to the poor, the report says.

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Source: MergerWatch

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Twitter chat on pregnancy and childbirth with Group Health’s Dr. Jane Dimer, Tuesday, December 10

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hashtagJane Dimer, MD – an OB/GYN and chief of Women’s Services for Group Health – on Tuesday, Dec. 10 from 12-1 pm for an hour-long Twitter chat on pregnancy and childbirth. Dr. Dimer will be covering a variety of topics from getting pregnant to delivery, and answering your questions.

Topics will include:

  • Preparing your body for pregnancy
  • Nutrition
  • Is this normal?
  • Pregnancy myths
  • Making a birth plan
  • Delivery
  • Back to work/breastfeeding

When: Tuesday, Dec. 10 from 12-1 pm

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State gonorrhea cases up 34 percent

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Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Not just the baby blues: Screening can help address postpartum depression

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PregnancyBy Dr. Carolyn Clancy
Director, US Agency for Healthcare Research and Quality

If you know someone who’s expecting a baby this summer, you have plenty of company. More babies are born in July, August, and September than in any other months of the year, according to 2010 Federal data [PDF File, Plugin Software Help].

A new baby brings joy and excitement. But for some women, it can also bring on the start of serious depression. Known as postpartum depression, this condition often starts shortly after a woman gives birth, but it can also begin up to a year later.

Signs of postpartum depression are similar to the symptoms of major depression. They include—

  • Feeling sad or depressed most of the time.
  • Having no interest in doing things a person used to enjoy.
  • Losing or gaining a lot of weight in a short time.
  • Being unable to sleep or sleeping too much.
  • Feeling guilty or worthless.
  • Thinking about death or suicide.

Major depression in women who have given birth in the previous year affects between 1 and 6 percent of the population. In the first 3 months after giving birth, the incidence is higher than 6 percent.

New mothers with postpartum depression have unique needs because they are caring for infants. When this condition isn’t treated, it can result in a higher risk of infant death, poor infant development, and a greater use of unneeded health services for mother and infant, a 2009 report found.

One problem is that the signs of postpartum depression can look the same as the natural stresses of caring for a newborn. Who doesn’t know a new mother who has been up all night—or several—with a crying infant? Women who are exhausted or sad might be mistakenly be diagnosed with this condition.

The good news is that women who get tested and treated for postpartum depression can recover faster from the symptoms than women who don’t, according to a new review from AHRQ’s Effective Health Care Program [PDF File, Plugin Software Help]

The review, conducted for AHRQ by Duke University with input from experts in child and maternal health, looked at 40 studies. About half of the studies used well-known depression screening tests to assess a woman’s risk.

Women who tested positive for depression did better when the screening, diagnosis, and treatment were all provided in the same place. Unfortunately, when these elements of care aren’t available in the same place, fewer than half of patients are referred for followup treatment.  Screening for postpartum depression can be helpful, especially when it’s convenient for patients.

Currently, we don’t have a “standard of care”—like the schedule of vaccines for children, for example—for the best type of depression screening test, who should receive it, and when it should be given. And we don’t have enough evidence about what which approach works best once a positive diagnosis is made.

Clearly, more research is needed. Postpartum depression is a serious condition whose signs can appear at a time when everyone—new mothers included—expects just the opposite. Understanding that it can be tested, diagnosed, and treated is a big step in the right direction.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality. Effective Health Care Program
Efficacy and Safety of Screening for Postpartum Depression. April 2013
http://www.effectivehealthcare.ahrq.gov/ehc/products/379/1437/postpartum-screening-report-130409.pdf [Plugin Software Help]

Centers for Disease Control & Prevention
National Vital Statistics Reports, Vol. 61, No. 1, August 28, 2012
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01_tables.pdf#I02 [Plugin Software Help]

U.S. National Library of Medicine, National Institutes of Health
Postpartum Depression: MedlinePlus
http://www.nlm.nih.gov/medlineplus/postpartumdepression.html

National Research Council, Institute of Medicine
Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. 2009
http://www.nap.edu/catalog.php?record_id=12565   

Current as of June 2013
Internet Citation: Not Just the Baby Blues: Screening Can Help Address Postpartum Depression. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/061113.html
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FDA approves “morning after pill” for over-the-counter sale

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planb-175The US Food and Drug Administration (FDA) has approved the so-called “morning after pill” Plan B One-Step for over-the-counter sale.

That means the emergency contraceptive can be purchased by all women of “child-bearing potential” without a prescription, the FDA said..

Plan B One-Step can prevent  pregnancy following unprotected sexual intercourse or a known or suspected contraceptive failure, such as may occur with a condom, if taken as soon as possible within three days after unprotected sex.

Plan B One-Step was first approved in July 2009 for use without a prescription for women age 17 and older and as a prescription-only option for women younger than age 17.

The  drug contains higher levels of a hormone found in some types of daily use oral hormonal contraceptive pills and works in a similar way to these contraceptive pills by stopping ovulation and therefore preventing pregnancy.

Plan B One-Step will not stop a pregnancy when a woman is already pregnant and there is no medical evidence that the product will harm a developing fetus, the FDA said.

The product, however, will not protect a woman from HIV/AIDS or other sexually transmitted diseases, and so it is important that young women who are sexually active see a healthcare provider for routine checkups, the FDA warned.

The health care provider should counsel the patient about, and test them for sexually transmitted diseases, discuss effective methods of routine birth control, and answer any other questions the patient may have, the FDA said.

Some women taking Plan B One-Step have reported experiencing the following side effects:  nausea, vomiting, stomach pain, headache, dizziness and breast tenderness. These are similar to the side effects of regular prescription-only birth control pills.

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UW Medicine to “affiliate” with PeaceHealth – Seattle Times

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seattle-times-logo-squareUW Medicine and PeaceHealth have agreed to create a “strategic affiliation,” with details to be spelled out by the end of September, Seattle Times health write Carol Ostrom reports.

PeaceHealth, a not-for-profit system based in Clark County and founded by the Sisters of St. Joseph of Peace, operates nine hospitals and physician groups in Alaska, Washington and Oregon, and a Medicaid health plan.

Ostrom writes:

The two organizations said they will remain legally separate and independent, but critics of such affiliations noted that after Swedish Medical Center used such language in an affiliation with Providence Health & Services last year, it stopped doing elective abortions and closed its hospice service.

The U.S. Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services restrict such services as abortion, birth control, sterilization and patients’ rights regarding end-of-life treatment.

Seattle Times staff columnist Danny Westneat questions the growing role of the Catholic church in healthcare in Washington state.

By the end of this year, half of our state’s medical system will be Catholic-run, as measured by number of hospital beds. That’s the highest share in the nation, and rising fast — up from about 30 percent just last year. Somehow our godless state has become Ground Zero for faith-based medicine.

He asks:

We’d never turn our education system over to one church to run. Why are we doing it with health care?

To learn more:

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Cloning, stem cells long mired In legislative gridlock

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IVF egg thumbBy Julie Rovner, NPR News

This story comes from our partner ‘s Shots blog.

The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997.

“The issue of legislation on human cloning is about to get hot again,” says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School.

But it’s a fight that has, over the past decade and a half, produced a lot of heat and light and not a lot of policy.

Human cloning

In fact, for all the arguing about the issue that’s happened in Washington over the years, human cloning is still technically legal, at least in much of the country.

“There are already 60 countries in the world that have laws on their books banning human reproductive cloning, and this prohibition is also in a number of international agreements” says Marcy Darnovsky, executive director of the Center for Genetics and Society, which is devoted to the responsible use of new genetic and reproductive technologies. “But in the U.S., we have not managed to put such a law on the books at the federal level.”

At least 15 states ban cloning, either for reproductive purposes or research or, in come cases, both, according to the National Conference of State Legislatures.

But Congress has mostly fought issues of both stem cell research and cloning to a draw.

“What we saw the last time cloning was in the headlines was that the discussion really got mired in the abortion controversy,” Darnovsky said.

The House passed bills banning all forms of cloning in 2001 and 2003; the Senate failed to act in both cases.

“All the other issues got completely swamped,” she said. “And I really hope that doesn’t happen this time.”

But both the issues of cloning — for research and reproduction — and embryonic stem cell research have been mired in the abortion controversy from the start.

Stem Cell Research

About the only law that has been able to pass is language that gets added to the funding bill for the Department of Health and Human Services every year since the mid-1990s — the so-called Dickey-Wicker Amendment, named for its original House sponsors, Reps. Jay Dickey, R-Ark., and Roger Wicker, R-Miss. It bars the use of federal funds for research that could destroy or harm a human embryo.

The Clinton administration decided that federal funding of embryonic stem cell research using cell lines derived from embryos destroyed with private funds did not violate that law.

President Bush put that policy into force but severely limited the cell lines available to researchers.

“I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life-and-death decision has already been made,” he said in a televised address to the nation.

Meanwhile, over the years Congress debated several bills to expand federal funding of embryonic stem cell research, under specific ethical guidelines, as well as legislation to ban cloning intended to make a baby. None, however, was able to pass both the House and Senate and get the president’s signature.

When he came into office in 2009, President Obama used his executive authority to expand federal funding for embryonic stem cell research, while maintaining guidelines such as not paying women for their eggs.

“The majority of Americans, from across the political spectrum, and from all backgrounds and beliefs, have come to a consensus that we should pursue this research,” he said.

FDA Rules

But Congress remains deadlocked over the bioethical issues — which is not to say that there is no federal regulation.

Jonathan Moreno, a bioethicist at the University of Pennsylvania, points out that the Food and Drug Administration has, from the start, said it would closely regulate anything it deemed to be human cloning, whether reproductive or therapeutic.

“Once you start talking about putting many of the products of these cells into people, then you get into an area where the FDA is very interested,” he said.

Meanwhile, Darnovsky of the Center on Genetics and Society says she hopes this new development might break the legislative logjam.

“This development, if it turns out to be replicable, will mean that there will be cloned human embryos in labs around the country,” she said. “And we really need to make sure that no unscrupulous person would ever try to use those to produce a cloned human being.”

Congress, however, has been unable to pass much of anything this year. It’s unclear yet if this will rise to the level of must-pass.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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New guidelines may drop birth control training rule

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CONTRACEPTIVEBy Julie Rovner, NPR News

This story comes from our partner ‘s Shots blog.

One of the more popular provisions of the federal health law requires that women be given much freer access to prescription methods of birth control. That includes not only the pill, but implants and IUDs as well.

But what happens if there are not enough doctors to prescribe those contraceptives?

That’s exactly what worries some reproductive health advocates, as efforts are underway to rewrite rules governing the training of the nation’s family doctors.

The proposed new rules, they say, drop existing requirements that family medicine residents be required to undergo training in contraception and counseling women with unintended pregnancies.

Several groups are now running letter-writing campaigns to make sure the rules remain.

Revising The Rules

Family physicians are what used to be known as general practitioners, or GPs.

“My youngest patient hasn’t been born yet, and the oldest I take care of is 94,” says Jeff Cain, president of the American Academy of Family Physicians and a family doctor in Denver.

For the majority of women, particularly outside major cities, it’s family doctors, not obstetrician-gynecologists, who provide for their reproductive health needs.

“The main people who staff community health centers, as well as large swaths of rural America, are family doctors,” says Linda Prine, a family physician from New York.

To become a family doctor, however, medical residents must complete a wide-ranging and rigorous three-year training program approved by the Accreditation Council on Graduate Medical Education.

Every seven years, the ACGME guidelines for each specialty are revised; it’s now time for a rewrite of the family medicine curriculum.

Prine, who is also the medical director of the Reproductive Health Access Project, helped lead a push the last time around to require all family medicine residents to learn to provide all forms of prescription contraceptives, including placing IUDs and implants, and to counsel patients with unintended pregnancies on their options.

“The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients,” she says.

But now that requirement appears to be going away.

“The feedback we’ve gotten over the years is that a lot of the curricular requirements were too specific,” says Peter Carek, a professor of family medicine at the Medical University of South Carolina and chairman of the committee that’s rewriting the requirements for family medicine residents.

“So in general what we’ve tried to do as a committee is to at least in as many areas as we could, pull back some of those specific requirements and give them more general requirements to follow,” he says.

Criticism

Reproductive health advocates say there’s a big problem with leaving contraception training up to each program: Many residency programs these days are run by religious hospitals that don’t believe in contraception.

“The way it works right now, the residency is required to at least send the residents off-site to another place, say, a family planning clinic where they can learn how to provide birth control,” Prine says. “If these regulations change and there’s no wording whatsoever about the need to provide contraception, the residency programs would no longer be obliged to send their residents somewhere where they would get this education.”

If you think that religious-based health care isn’t becoming the norm, think again.

“We took a look recently and found that of the 25 largest health systems in the United States, 13 were religiously sponsored; that includes 11 Catholic systems,” says Lois Uttley, who heads the nonprofit group MergerWatch, which works to protect women’s access to reproductive health care when secular hospitals merge with religious ones. “So that means the likelihood of a patient encountering a Catholic restriction on contraception is pretty high and growing.”

Draft Document

Family medicine officials, however, say they are aware of the concerns from reproductive health advocates.

“The American Academy of Family Physicians and family medicine educators really remain committed to ensuring that women’s health is a core educational part of training family physicians,” says Cain, the AAFP president. “That includes family planning and maternity care.”

Cain says that while the new program standards may not spell out the contraceptive training requirements the way the current ones do, he expects they will be included in a frequently asked questions part of the document that will still carry the same weight.

In any case, he points out, “the truth is this is a draft document right now. We want to make sure the wording in the document reflects the intended outcome.”

Both Cain and Carek say they are taking under serious consideration all the comments they have been hearing about the standards so far.

The last day for the public to comment is Thursday.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teens and Sexual Assault, Part 8: The Media’s Response to the Steubenville Convictions

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Photo by Brainloc

Photo by Brainloc

By
This article first appeared on Seattle Children’s Teenology 101 blog.

I thought Part 7 was my last post in the series, but the media response to the sentencing of the two rapists in the Steubenville case has been so outrageous that I’m going to tack on a postscript here.

One of the first news reports to come out after the conviction was from CNN, and it spent much more time sympathizing with the rapists than the victim- in fact, the victim was not mentioned. You can watch the video here.

A concerned Poppy Harlow states, ”It was incredibly emotional, incredibly difficult even for an outsider like me, to watch what happened, as these two young men, that had such promising futures, star football players, very good students, literally watched as they believed their life fell apart…”

She then goes on to describe said emotion in the courtroom, and the offenders’ sadness. Later on, another reporter asked a legal correspondent, “What’s the lasting effect of two young men being found guilty in juvenile court of rape, essentially?”

There is so much wrong there: the concern over the rapists, the “essentially” tacked on to “rape”, the complete and utter absence of any thoughts of the victim. Just as people were beginning to criticize CNN, it turned out that the problem was not just with them.

NBC kept talking about the rapists’ “promising football careers.” I’m not sure why that’s relevant.

ABC News ran a piece on Ma’lik Richmond that talked extensively about his athletic prowess and difficult childhood. And yet, many athletes with difficult childhoods have refrained from raping someone.

Good Morning America mentions that “A juvenile judge will decide the fates of Trent Mays and Ma’lik Richmond, who face incarceration in a detention center until their 21st birthdays and the almost-certain demise of their dreams of playing football.” Perhaps if you dream of playing football, it’s best not to commit a sex crime.

The Associated Press opens a story with “Two members of Steubenville’s celebrated high school football team were found guilty Sunday of raping a drunken 16-year-old girl.” They are celebrated high school football players, the victim is left with the epithet “drunken.”

What none of these major media outlets seem to be addressing is that (ideally) if you rape someone, you pay the consequences for it. None of them are lamenting the long-term effects on a young women of being raped by two young men (and having pictures of it sent to peers). None of them are pointing out that this situation wouldn’t have happened if the two offenders had made the choice not to rape someone. Their promising football careers would be continuing untouched, they might have gone to great universities, and enjoyed all the opportunities and rewards given to people who have chosen not to commit rape.

What are our teens supposed to think when the mainstream media’s treatment of rapists is not full of revulsion, fear, or condemnation, but seems almost… affectionate? At the least, they feel very bad for them.

And they fail to mention concern over the fate of the rape victim. In fact, if she’s mentioned at all, it’s to point out that she was intoxicated. As Henry Rollins (yes, thatHenry Rollins) said in a piece in Raw Story, “It is ironic and sad that the person who is going to do a life sentence is her.”

I spoke earlier in this series about how important it is to talk to your teen about issues regarding sexual consent. It’s also important for you to talk to your teen about rape culture, how they can make sure they’re not a part of it, and what they can do to change it.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Federal judge strikes down age limits on ‘morning-after’ pill

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planb-175By Scott Hensley, NPR News

This story comes from KHN partner ‘s Shots blog.

A federal judge in Brooklyn, N.Y., has ruled that the morning-after pill for emergency contraception must be made available over the counter to girls 16 and under.

The ruling could end a more than decade-long battle over how easy or difficult it should be for teenage girls to obtain emergency contraception.

The ruling would also make it easier for older women to obtain the drug because it wouldn’t have to be kept behind drugstore counters anymore.

The judge’s order effectively overturns a controversial 2011 decision by Secretary of Health and Human Services Kathleen Sebelius overruling the Food and Drug Administration. A

fter years of study and internal debate, the FDA had decided that Plan B One Step should be allowed for sale without a prescription — and without age restrictions.

In the ruling dated April 4, Senior Judge Edward R. Korman of the Eastern District of New York held that Sebelius’s decision on Plan B was “arbitrary, capricious, and unreasonable.”

On page 47 of the 59-page decision, Korman skewers Sebelius’s decision, calling it “politically motivated, scientifically unjustified, and contrary to agency precedent ….”

He also slammed the FDA’s rejection of a so-called Citizen’s Petition dating to 2005 that argued for the agency to approve unfettered over-the-counter sale of Plan B. That rejection, he said, was a direct consequence of Sebelius’s ruling.

In the decision, Korman sends the Plan B case back to FDA with orders to make the morning-after pill “available without a prescription and without point-of-sale or age restrictions within 30 days.” If the agency decides the instructions for the drugs need tweaks, that’s OK.

When Sebelius essentially vetoed the FDA’s decision in late 2011, women’s health groups erupted in protest. “As doctors and researchers have repeatedly stated, ample research shows Plan B to be safe for women of all ages and appropriate for over-the-counter access.

It is deeply disappointing that this administration would repeat the mistakes of the previous one,” said Susan Wood, an associate professor at George Washington University’s School of Public Health.

Wood was an assistant commissioner for women’s health at the FDA but quit in 2005 over its continued delay on over-the-counter approval for Plan B.

Advocates for Plan B kept up the pressure on the administration to reverse itself. They argued, in part, that the rules were just too complicated.

“The unique dual-labeling of Plan B One Step has led to confusion among consumers and health care professionals alike, particularly regarding age restrictions and whether men and women can purchase non-prescription emergency contraception,” said a letter signed by more than three dozen women’s health, reproductive rights and individual providers of health care.

“A recent Boston University study of 943 pharmacies in five major cities revealed that, when called posed as 17 year olds seeking EC, one in five were told they could not purchase EC under any circumstances,” the letter said at the time. In fact, those 17 and older are eligible to purchase the product without a prescription; those 16 and younger may purchase it with a health provider’s written order.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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C-Section rates vary widely across nation

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Courtesy of Salim Fadhley, Wikipedia

By Alvin Tran

Rates of C-section deliveries vary widely across the nation, according to the findings of a new study.

The study, published Monday in the journal Health Affairs, found that the overall rates of C-sections — the most common type of surgery in the U.S. — varied from about 7 to 70 percent  across the nation’s hospitals.

Researchers also found a wide variation in C-section deliveries even among women with lower-risk pregnancies, where rates varied from 2.4 to 36.5 percent. According to the study, cesarean deliveries are much more expensive than vaginal births.

“We were really surprised by how much variation we saw,” said Dr. Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.

The research team analyzed 2009 data from more than 1,000 hospitals in 44 states, taking patient characteristics into account as well as hospitals’ size, teaching status and geographic location.

The study’s findings suggest that small and rural hospitals showed more variability in C-section rates compared to other hospitals. Teaching hospitals, however, showed less variation in overall C-section rates.

Despite concerns about overuse of cesarean deliveries, Kozhimannil cautioned that some of these surgeries will always be necessary and researchers should be careful to not make doctors too uncomfortable about performing a cesarean.

“When you see variation in something, it could suggest overuse or either underuse. I think it’s important to look out for underuse as well,” Kozhimannil added. “Cesarean deliveries save lives and every woman who needs a cesarean delivery should have one.”

Dr. William Grobman, a spokesman for the American College of Obstetricians and Gynecologists and a professor in obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University, said that it is important to “encourage deliveries that can be safely undertaken vaginally to occur and not to do unnecessary cesareans.”

In an interview, Grobman said the high number of cesarean deliveries has big consequences for health care costs and use and doctors consider different standards when weighing the procedure.

Though her study was unable to explain why the variation in cesarean deliveries exists, Kozhimannil is optimistic that future research — studies that analyze the financial and payment incentives in place for managing pregnancy care — may help answer the question.

“I think it is important to look beyond the woman and her characteristics and beyond the clinicians and their characteristics and really look at the system-level factors that are driving these variability and patterns in care,” she said.

The study makes four key recommendations, including better coordination among providers of maternity care to help reduce the need for C-sections and better data collection on the procedure.

The researchers also called for Medicaid, which funds nearly half of all U.S. births, to use its clout to help improve hospital obstetric practices.

And they suggested that new policies be implemented to empwer patients to help make decisions on their deliveries and to make data on the procedure more widely available.

“I think the fact that pregnant women cannot look up unbiased, easily available information on cesarean delivery rates in the hospitals from which they’re choosing is a problem that should be rectified,” Kozhimannil said.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Michelle Andrews answers to readers’ health insurance questions

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This week, I answer readers’ questions about birth-control coverage requirements under the Affordable Care Act and subsidized coverage on the state-based health insurance exchanges.

Q: Regarding contraceptive coverage, some non-grandfathered plans, while initially offering no-cost contraceptives, have now informed their group members that only certain generic oral contraceptives are covered at no cost. Brand treatments are subject to co-pays. How can they get away with that?

A: They can’t, except under a few conditions.

Under the health law, most employers and insurers have to cover all FDA-approved methods of birth control for women without charging members any out-of-pocket costs.

The list includes birth control pills, intrauterine devices, hormonal shots and implants, the patch and contraceptive sponges, as well as sterilization.

(Certain religious employers as well as plans that are grandfathered under the law are exempt from these requirements.)

But new guidance released by the federal government last month says health plans can use “reasonable medical management techniques” to keep their costs under control.

So if there is both a generic and a brand-name version of a birth-control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

If there is no generic version of a pill available, or if a woman’s doctor decides a brand-name version of a drug would be better for her than a generic, health plans have to cover the cost of the drug.

Q: I’m in a pre-Medicare retirement insurance plan offered by my employer, but it is very expensive. After Jan. 1, 2014, will I be able to apply for alternate insurance through the health exchanges and get my insurance at a lower price?

A: Anyone can buy a plan on his health insurance exchange, which will be running in January. If you meet certain criteria, you may also be eligible for a federal tax credit to help make the coverage more affordable. 

Retirees who are offered employer-sponsored coverage will have to meet the same eligibility standards for tax credits as active employees who are offered coverage through their jobs, says Sabrina Siddiqui, a spokeswoman for the Treasury Department.

To qualify for a tax credit, the coverage offered by an employer must be either unaffordable, which is defined as having a premium that exceeds 9.5 percent of household income for individual coverage, or inadequate, meaning that it covers less than 60 percent of allowed medical costs.

If a retiree’s coverage is considered unaffordable or inadequate by those standards and if his household income is between 100 percent and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013), he could be eligible for a premium tax credit, according to the Treasury Department.

Q: I live in Georgia, which has refused the Medicaid expansion. Is there any legislation in the works for those individuals who are below the federal poverty level who reside in states that are not expanding Medicaid?

A: Low-income people who live in states that have decided not to implement the Affordable Care Act’s Medicaid expansion are in a tough spot. But given the political divisiveness of this issue, experts say the likelihood of a legislative fix for this problem is small.

In many states, Medicaid eligibility is tightly restricted. The health law called for states to expand that eligibility to people with incomes up to 138 percent of the federal poverty level ($15,856 for individuals in 2013).

But the Supreme Court ruled last year that states are not required to do so. About half the governors so far have announced that they want to go forward with expansion of the federal-state health program for low-income people.

If you don’t qualify for Medicaid and your state has decided against expanding eligibility for the program, you can look for a plan on the health insurance exchange.

But ironically, you may not make enough money to qualify for the federal premium subsidies that will be offered to people with incomes between 100 and 400 percent of the poverty level.

Without that financial help, coverage will likely be unaffordable, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

“You probably can’t get coverage [on an exchange] even though you’re more needy than someone with higher income,” Park says.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Please send comments or ideas for future topics for the Insuring Your Health column to:

questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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