The United States has a higher rate of babies born too early – and therefore at greater risk of death or health problems – than more than 125 other countries, including Rwanda, Uzbekistan, China and Latvia, according to a report out today.

About 12 percent of U.S. babies are born at 37 weeks or less, according to the report, which found a worldwide range of as few as 4.1 percent of babies in Belarus to as many as 18 percent in Malawi. Full term is considered 39 weeks.

Click to view interactive map and charts

While nearly two thirds of all pre-term births worldwide occur in Sub-Saharan African and Asia, the U.S. rate shows that “this is not just a developing country issue,” says Chris Howson, vice president for global programs at the March of Dimes.

His organization, along with the World Health Organization, Save the Children and the Partnership for Maternal, Newborn & Child Health, produced the report. It says about one million pre-term babies worldwide die shortly after birth, while others can suffer lifelong health problems.

Born Too Soon is a joint effort of almost 50 organizations, including the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s.

“This report sounds the alarm that prematurity is an enormous global health problem that urgently demands more research and resources,” said Craig Rubens, MD, PhD, executive director of GAPPS and contributor to the report.

“Even if every known intervention was implemented around the world, we would still see 13.8 million preterm births each year; we could only prevent 8 percent,” he said.

Maternal risk factors include being under- or over-weight, having diabetes or high blood pressure, smoking, being younger than 17 or over age 40.

Rates within countries can vary widely. In the U.S., for example, the pre-term birth rate for white women in 2009 was 10.9 percent, compared with 17.5 percent for African American women, the report says.

In the U.S. and some other developed countries, pre-term births are also linked with a higher use of fertility drugs, which are associated with mothers carrying twins, triplets or more, increasing the chance of early labor. Some births in the U.S. are also induced early, either because the mother is having health problems or for the convenience of the doctor or mother.

Because pre-term births are costly and dangerous, physician groups, organizations like the March of Dimes and even some employers have ongoing efforts to discourage women and their doctors from scheduling births before 39 weeks, unless there is a health reason to do so. The Obama administration launched a $40 million program in February aimed at reducing the number of premature births, especially elective deliveries.

Those elective early births are also the subject of a March of Dimes education campaign, which says even though the absolute numbers are small, the risk of death for babies born just one to two weeks early is twice as high as for those born at 39 weeks.

Howson says the groups that signed on to the report have made a variety of suggestions for lowering the rate worldwide, ranging from inexpensive injections that can be given to mothers in preterm labor to help develop fetal lungs to encouraging women to have health exams before they get pregnant to check for risk factors.

“A preterm baby indicates a failure in the system,” he says.

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.

Photo: Matthew Bowden

By Judith Graham

Opponents of the Obama administration’s contraceptive coverage mandate – including likely GOP presidential nominee Mitt Romney – invoke “religious freedom.”

But women’s groups and family planning organizations are convinced that the real objective is to limit access to birth control.

“There is a lot of deliberate obfuscation going on with the purpose of pretending that this debate is not really about birth control, when it most definitely is,” said Susan Cohen, director of government affairs for the Guttmacher Institute, a family planning research and policy institute.

Cohen points to efforts in Congress over the past year to defund Planned Parenthood and eliminate funding for Title X family planning services for low-income women as further evidence of social conservatives’ increasingly public antagonism to birth control.

“I’ve been doing this for over three decades and I don’t remember such overt attacks on contraception in all that time,” she said.

No other health care service mandated under state or federal law has provoked a similarly furious response, and that’s not accidental, said Marcia Greenberger, co-president of the National Women’s Law Center.

“Much of the opposition being voiced is, in fact, being driven by opposition to contraception,” she said.

While churches are excluded from the mandate, religious hospitals, colleges and social service agencies are not.  Attempts to strike a compromise have so far proved unsuccessful.

Battles over contraception are also being fought in the states. Five states (Arizona, Georgia, New Hampshire, New Jersey and New York) are considering bills that would give religious employers, broadly defined, greater freedom to opt out of contraceptive coverage mandates.   Similar “refusal” legislation is being advanced in Idaho and Oklahoma, although neither state has a mandate.

Catholic bishops make no bones about their church’s condemnation of birth control, but other organizations that oppose the Obama administration’s contraceptive policy haven’t embraced that position.

Particularly noteworthy is the stance of groups that have led the nation’s decades-long fight against abortion. Publicly, these groups say they are against the coverage mandate because it violates religious freedoms and claim that they don’t take a stand on contraception.

But that doesn’t tell the whole story.  Without much fanfare, pro-life organizations often link some kinds of birth control with abortion, the issue that most inflames social conservatives, and discourage the use of some types of contraception.

In a Feb. 10 statement, the Family Research Council decried the contraceptive mandate for being “fundamentally anti-religious, anti-conscience and anti-life.”

Asked to elaborate, Jeanne Monahan, director of the group’s Center for Human Dignity, said “we are 100 percent pro-life from the moment of fertilization or conception and we are opposed to any contraceptive that would have an abortion-inducing mode of action.”

In the view of the Family Research Council, this includes certain intrauterine devices and emergency contraception products known as Plan B and Ella.

In late February, Monahan testified against “drugs and devices that destroy, rather than prevent life” before the House of Representatives’ Judiciary Committee — a reference to products that keep a fertilized embryo from implanting in or being retained by a woman’s uterus.

While this effect hasn’t been proved and is questioned by many scientists, it is mentioned as a possibility on the label of products such as Yaz, a popular version of the pill.

The National Right to Life Committee and other pro-life organizations do not accept the notion that pregnancy begins when a fertilized egg successfully implants in a woman’s uterus — the definition advanced by the American College of Obstetricians and Gynecologists and other medical authorities.

Instead, they believe life begins at the moment of conception, an idea being advanced through so-called “personhood” legislation being promoted across the country.

“No one is advocating that birth control be eliminated or made more difficult to get,” said Carol Tobias, president of the committee.  But, she acknowledged that “if there is a method of contraception that may also be an abortifacient, we encourage women not to use it.”

Her group worries that if the contraceptive coverage mandate is enacted and President Barack Obama wins the election in November, “he’s going to include abortion in the mandate,” Tobias said.

Focus on the Family said in a statement from Carrie Gordon Earll, senior director of issues analysis, that it “views the role of contraception as one to be determined in marriage between a husband and wife in accordance to their faith.”

The organization gives more details on its website, where it affirms its conviction that “life begins with fertilization (the union of sperm and egg).”

While agents that prevent fertilization from occurring are acceptable, those that act after fertilization are not, it states. Pills that include progesterone only and Norplant, a progesterone-releasing implant placed under the skin, fall in this suspect category and should be avoided, but those including both progesterone and estrogen – the most common variety – appear to be acceptable, it suggests.

“Concerned Women for America takes no official position on birth control,” communications coordinator Alison Howard said in an e-mail. But in a statement about the contraceptive mandate on its website, the group says, “Requiring employers affiliated with the Christian faith, like Concerned Women for America, to include free abortion-inducing drugs in their health insurance plans is contrary to both Christian doctrine and constitutional guarantees of religious freedom.”

How the public understands the forces at play in the ongoing debate over the contraceptive coverage mandate may well determine its political resolution and resulting public policy.

An overwhelming majority of Americans strongly support access to birth control and appear poised to reject any attempt to limit it, according to multiple polls.

For the moment, it appears that reproductive health advocates have gained an advantage: 62 percent of people responding to a recent Bloomberg National Poll said they believe the controversy is about women’s health and access to contraception while 33 percent said it was about “religious liberty.”

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.

A bill that would require insurers to cover abortion services is off the table this year in Washington state.

A special session of the Washington legislature ended Wednesday without the Reproductive Parity Act reaching a vote. The bill would require private insurers that provide maternity coverage to also cover abortion.

Advocates now hope to reintroduce the bill next year.

“We will be back in 2013,” said Lisa Stone, executive director of Legal Voice, a nonprofit focused on women’s rights in the Northwest. “We think it can pass, and we’re not going to stop until it does.”

Another option for the Reproductive Parity Act would be a state ballot initiative, but advocates have no such plans for this election year, said Alison Mondi, a spokeswoman for NARAL Pro-Choice Washington.

Stone expressed confidence the bill would have the votes necessary for passage if it made its way to the floor again. Legislative action would also be far cheaper than a ballot initiative, she said.

Advocates had expected the Reproductive Parity Act to pass this year, given a Democratic-controlled House and Senate, and an expected signature from Democratic Gov. Christine Gregoire.

But this year’s push was marred by “bad luck,” according to Stone. While under consideration, the bill faced its share of challenges.

For instance, it was amended in order to provide insurers a religious/conscience exemption and to avoid conflict with federal law. The latter raised concerns among members of Congress, who wrote a letter to President Obama warning the bill “would have far reaching and alarming consequences for the citizens of Washington state who embrace life.”

And in the end, after making it through the House, the bill was blocked by Senate procedural maneuvers related to the budget, and it fell prey to the uncertainty of a special legislative session.

According to Stephanie Marquis, a spokeswoman for Washington’s insurance commissioner, all individual and small-group plans in the state already cover abortion, but information about employer-based plans is unavailable.

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.

Huffington Post: Women’s Health Care Is Stronger Thanks To The Health Care Law

In many families, women are the health care decision makers. When children go for their checkups, we are often the ones who make the appointment and sit in the room holding their hand. When elderly parents see a new specialist, we are the ones carrying the folder with all their health information. … In the past, this also meant that many women would take care of their own health last. By the time they got around to it, women found a system stacked against them. But thanks to the health care law, that’s changed (Kathleen Sebelius, 3/20).

The New Yorker: Holding Court

Late last year, a three-judge panel of the D.C. Circuit [Court of Appeals] voted, two to one, to uphold President Obama’s health-care reform, known as the Affordable Care Act (ACA). [Brett M.] Kavanaugh dissented, primarily on the ground that the lawsuit was premature. … “Under the Constitution,” Kavanaugh wrote, “the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional.” … In other words, according to Kavanaugh, even if the Supreme Court upholds the law this spring, a President Santorum, say, could refuse to enforce ACA because he “deems” the law unconstitutional. That, to put the matter plainly, is not how it works (Jeffrey Toobin, 3/26).

Governing: What Will The Supreme Court Ask About Health Reform?

If the court decides to rule on the lawsuit, a decision is expected by the end of June before the conclusion of the court’s current session. That decision has heavy implications for states. The ACA includes an extensive expansion of Medicaid (expected to add up to 20 million people to the program’s rolls) and asks states to create a health insurance exchange where individuals and small businesses can compare and purchase insurance plans. Market reforms, such as rules for the medical loss ratios that insurance companies must maintain, would also require cooperation from state governments (Dylan Scott, 3/15). Photo: Franz Jantzen

The Atlantic: The Most Scientific Birth Is Often The Least Technological Birth

When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. … Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it (Alice Dreger, 3/20).

TIME: Inside America’s Drug Shortage

Lynn Divers thought she had heard the worst of it when doctors told her that her daughter Alyssa had cancer. … Then came the truly heartbreaking news. In late February, when Divers called the hospital to confirm Alyssa’s upcoming chemotherapy treatment, the nurse informed her that there was a drug shortage. The hospital couldn’t be sure that there would be enough methotrexate — the cornerstone of therapy for some childhood cancers, including leukemia and osteosarcoma — to treat Alyssa, now 10. … How did this happen? How could hundreds, perhaps thousands of cancer patients suddenly find themselves without the drug treatments that could save their lives? (Alice Park, 3/19).

American Medical News: The ABCs Of Health Literacy

One in three patients has “basic” or “below basic” health literacy, meaning he or she struggles with tasks such as completing a health insurance application or understanding a short set of instructions about what liquids to avoid drinking before a medical test. This literacy gap has medical consequences. A wide body of research has found that patients with poor literacy skills have much worse health outcomes than patients who can read well. They make more medication or treatment errors, are less compliant and are 50% likelier to be hospitalized, says the National Patient Safety Foundation. Low-literacy patients with chronic diseases … rack up four times more in annual medical costs than patients with higher reading ability (Kevin B. O’Reilly, 3/19)

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.

A new study finds U.S. physicians are performing Pap smears far more often than needed to prevent cervical cancer.

The study, published in The Milbank Quarterly, examines Pap smear usage alongside cervical cancer mortality data in the U.S. and the Netherlands between 1970 and 2007.

Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCI

While American doctors performed about three or four times as many Pap smears as Dutch doctors did, the rates at which women developed or died from cervical cancer were roughly equal for the two nations.

“This strongly suggests that the Dutch approach to cervical cancer screening is much more efficient than the U.S. approach. We did detect some potential shortcomings in the Dutch approach, but the evidence suggests that the U.S. could move substantially in the direction of the Dutch program, at considerable economic savings, without sacrificing health benefits,” said co-author Martin L. Brown, Ph.D., of the National Cancer Institute.

KEY POINTS

• In the U.S., women received three to four times the number of Pap smears over a period of three decades as women in the Netherlands, yet the two countries’ cervical cancer mortality rates were similar.

• The Netherlands follows a model of screening based on governmental guidelines; the U.S. has traditionally followed a model based on decisions by individual physicians, insurance plans and guidelines from medical organizations.

The Netherlands has long treated cancer screening as a national public health endeavor carried out by doctors who generally follow National Ministry of Health guidelines, the study reports.

Meanwhile, the U.S. follows a medical model: individual doctors choose who to screen and how often. U.S. doctors select from or ignore guidelines from various organizations and from the government’s U.S. Public Health Service.

Overall, in the Netherlands, cancer screenings adhere to the most recent evidence. There, a woman generally undergoes a lifetime total of 7 Pap smears between ages 30 and 60. Doctors typically screen patients every five years, depending on their age and risk level.

“In the U.S., actual medical practice lags behind and diverges strongly from evidence-based guidelines,” says Brown. Screening guidelines U.S. doctors adopt from highly influential medical societies vary widely, calling for anywhere from 20 to 33 Pap smears. Screenings often take place annually, without regard for a woman’s age or risk.

While the study discussed only cervical cancer evidence, the authors did note that its themes might apply to differences in screening for many preventable diseases.

Darcy Phelan, DrPH with the Johns Hopkins Bloomberg School of Public Health, hopes that policy makers will consider these findings as they address ways of preventing cervical cancer that are more efficient. “These findings suggest that broad adoption of a policy to extend the Pap screening interval will protect patient safety while reducing costs. This will be especially important as prevention costs escalate in the context of human papillomavirus (HPV) vaccination among girls and young women.”

Both experts noted that the U.S. Preventive Services Task Force included extension of the interval in its recently updated cervical cancer screening guidelines.

Phelan added that the study confirms the importance of screening all women, as most cervical cancers occur among those never screened or not screened within the recommended interval.

Screening all women has great potential to reduce persistent racial and ethnic disparities in cervical cancer in the U.S., she says.

Health Behavior News Service is part of the Center for Advancing Health

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.