Category Archives: Women’s Health

Telemedicine under attack as abortion rights supporters seek more options for women

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Photo by Brainloc

By Michelle Andrews
KHN

The House of Representatives’ approval last week of a bill to ban abortions after 20 weeks brings into sharp focus the issue of early access to abortion.

Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.

Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers.

Iowa and Minnesota are the only states that offer so-called “telemed” abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy.

Supporters of telemed abortions say it increases the odds that a woman will be able to get an abortion earlier in her pregnancy, when the procedure is safer and cheaper, and in areas where providers are stretched thin.

In 2011, 89 percent of counties nationwide had no clinics that provided abortion services, according to the Guttmacher Institute, and more than a third of women of childbearing age lived in those counties.

Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers to boost the number of abortions they can provide.

Photo courtesy of Brain Loc

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‘Free’ contraception means ‘free,’ Obama administration tells insurers

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Birth control patch - Photo by John Heilman, MD under creative commons licesnse

Birth control patch – Photo by John Heilman, MD (CC)

By Phil  Galewitz
KHN

Free means free.

The Obama administration said Monday that health plans must offer for free at least one of every type of prescription birth control — clarifying regulations that left some insurers misinterpreting the Affordable Care Act’s contraceptive mandate.

“Today’s guidance seeks to eliminate any ambiguity,” the Health and Human Services Department said. “Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified … including the ring, the patch and intrauterine devices.”

The ruling comes after reports by the Kaiser Family Foundation and the National Women’s Law Center, an advocacy group, found many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.) Continue reading

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Home visits by nurses for first-time mothers help reduce costs

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Symphonie Dawson and her son Andrew.

By Michelle Andrews
KHN

Symphonie Dawson was 23 and studying to be a paralegal while working part-time for a temporary staffing agency when she learned that the reason she kept feeling sick was because she was pregnant.

Living with her mom and two siblings near Dallas, Dawson worried about what to expect during pregnancy and what giving birth would be like, not to mention how to juggle having a baby with being in school.

(Photo courtesy of Symphonie Dawson)

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How one hospital brought its C-sections down in a hurry

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In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.  The Newport Beach hospital has been working to lower the amount of c-sections by stepping up data analysis and patient education (Photo by Heidi de Marco/Kaiser Health News).

In 2012, Hoag Hospital’s cesarean section rate was about 38 percent – five percent higher than the state average.(Photo by Heidi de Marco/Kaiser Health News).

By Anna Gorman
KHN

NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.

“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.

The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.

Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.

In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.

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More evidence health plans stint on mandated birth control coverage

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Woman's HeadBy Julie Rovner
KHN

Women’s health advocates were thrilled when the Affordable Care Act became law in 2010, because it required insurance companies to cover a broad array of women’s health services at no additional out-of-pocket cost beyond premiums.

Five years later, however, that requirement is not being enforced, according to two new studies. Health insurance plans around the country are failing to provide many of those legally-mandated services including birth control and cancer screenings.

The studies by the National Women’s Law Center looked at health plan coverage documents and consumer complaints in 15 states. One of the studies focused on contraception, while the other looked at a range of women’s health issues, including maternity care, breast-feeding support and other services.

“We found some very clear violations of the law,” said Karen Davenport, the group’s director of health policy. Among the companies named as not complying with the law’s requirements in at least some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield. Continue reading

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Women’s Group Says Insurers Aren’t Meeting Health-Law Requirements – WSJ

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Woman's HeadThe National Women’s Law Center, a feminist group that strongly backs the health law, said in a report that it had found widespread violations across more than a dozen states where it investigated new plans sold on the exchanges.

The center, which is based in Washington, D.C., also said it had received complaints on a hotline from women in every state about how the rules were working, including in coverage provided by an employer.

Source: Women’s Group Says Insurers Aren’t Meeting Health-Law Requirements – WSJ

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Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD

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Blue Pregnant BellyUse of prescription narcotic painkillers is common in pregnancy and increases the likelihood a baby will be born small or early, or go through painful drug withdrawal, a new study finds.

These prescription painkillers, also called opioids, include drugs such as hydrocodone (Vicodin), oxycodone (Oxycontin), codeine and morphine.

Nearly 30 percent of the Tennessee mothers-to-be in the new study used at least one of these drugs while pregnant, and the associated risks went up if they also smoked or took antidepressants.

via Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD.

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Teen Use of Long-Term Contraception Rising, But Remains Low – WebMD

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A diagram showing a hormonal IUD in the uterusThe use of long-acting, reversible forms of contraception remains low among sexually active teen girls, though that trend seems to be changing, according to a U.S. government report released Tuesday.

Among teens aged 15 to 19, the use of long-acting reversible contraception rose from less than 1 percent in 2005 to about 7 percent in 2013, according to the federal Centers for Disease Control and Prevention.

via Teen Use of Long-Term Contraception Rising, But Remains Low – WebMD.

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States reluctant to regulate fertility services

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IVF egg thumbBy Michael Ollove
KHN

The Utah legislature took a step last week into territory where state lawmakers rarely tread.

It passed a law giving children conceived via sperm donation access to the medical histories of their biological fathers. The law itself stirred no controversy. The oddity was that the legislature ventured into the area of “assisted reproduction” at all.

Assisted reproductive technology (ART) helps infertile couples to conceive. Compared to many other industrialized nations, neither the U.S. nor state governments do much to oversee the multibillion-dollar industry.

“The United States is the Wild West of the fertility industry.”

“The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society said, echoing a description used by many critics of the regulatory environment surrounding ART. Continue reading

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Unplanned pregnancies cost US $21 billion a year

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Close up on a pregnant woman's belly cradled by her hands

Government spending on the births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21.0 billion in 2010, according research by the non-profit Alan Guttmacher Institute.

Highlights:

  • Nationally, 51% of all U.S. births in 2010 were paid for by public insurance through Medicaid, the Children’s Health Insurance Program and the Indian Health Service.
  • Public insurance programs paid for 68% of the 1.5 million unplanned births that year, com- pared with 38% of planned births.
  • Two million births were publicly funded in 2010; of those, about half—one million—were unplanned.
  • A publicly funded birth in 2010 cost an average of $12,770 in prenatal care, labor and delivery, postpartum care and 12 months of infant care; when 60 months of care are included, the cost per birth increases to $20,716.
  • Government expenditures on the births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21.0 billion in 2010; that amounts to 51% of the $40.8 billion spent for all publicly funded pregnancies that year.
  •  In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 might have been 75% higher.

Photo by Bies

To read the full report here.

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Racial and ethnic disparities persist in teen pregnancy rates

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African-American and Latina girls are more than twice as likely as white girls to become pregnant before they leave adolescence, which continues to confound states.

SLN_Feb03_teenpregnancy

By Teresa Wiltz
Stateline

LaNita Harris of the Oklahoma City County Health Department explains two of the posters the department uses in its Teen Pregnancy Prevention program. Although teen pregnancy and birth rates have dropped the past two decades, states still face the reality that black and Latina teens are more than twice as likely as white teens to become pregnant. (AP)

It’s a problem once thought to be intractable, and yet pregnancy and birth rates for black and Latina teens have dropped precipitously in the past two decades—at a much faster clip than that of white teens.

Despite this, black and Latina girls are more than twice as likely as white girls to become pregnant before they leave adolescence.

This glass half-full, half-empty scenario is a dilemma that continues to confound states. The racial and ethnic disparities surrounding teen pregnancy are stubborn, often a cause and consequence of poverty and a complex array of societal factors.

Teen pregnancies are usually unplanned and come with a steep price tag, costing U.S. taxpayers up to $28 billion a year, according to the Office of Adolescent Health, which is part of the U.S. Department of Health and Human Services.

Some states like Mississippi have found innovative ways to tackle the problem by targeting specific populations, while others like Kansas are serving up bills that make it more difficult for teens to access sex education, which is a critical component of preventing pregnancy in adolescence, according to advocates such as the National Campaign to Prevent Teen and Unplanned Pregnancy. Continue reading

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Pregnant and uninsured? Don’t count on Obamacare

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Blue Pregnant BellyBy Phil Galewitz
KHN

The Obama administration often touts the health benefits women have gained under the Affordable Care Act, including the option to sign up for coverage outside of open enrollment periods if they’re “having a baby.”

But advocates complain the special insurance enrollment period begins only after a birth. As a result, uninsured women who learn they are pregnant outside of the regular three-month open enrollment period, which this year ended Sunday, can get stuck paying thousands of dollars for prenatal care and a delivery — or worse, going without  care.

The special insurance enrollment period begins only after a birth.

The advocacy groups, including the March of Dimes, Planned Parenthood and Young Invincibles, are asking the administration to allow women to sign up whenever they become pregnant – a change opposed by the insurance industry. They say they’ve sought the change unsuccessfully for several years. Continue reading

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Colorado’s pregnancy prevention breakthrough

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Flag_of_ColoradoBy Christine Vestal
Stateline

President Barack Obama hailed a landmark achievement in his State of the Union address last month: Teen pregnancies in the U.S. have hit an all-time low.

But the U.S. still has a teen birthrate of 31.2 per 1,000 teens, nearly one-and-a-half times the rate in the United Kingdom, which has one of the highest rates in Western Europe.

Colorado may have found a way to close the gap. The state’s teen birthrate dropped 40 percent between 2009 and 2013, driven largely by a public health initiative that gives low-income young women across the state long-acting contraceptives such as intrauterine devices (IUDs) and hormonal implants.

Colorado has a successful model for stemming teen pregnancies. But will state lawmakers continue paying for it?

Backed by $23.5 million from the Susan Thompson Buffett Foundation, Colorado attracted national recognition for its program after Democratic Gov. John Hickenlooper announced the results of a cost-savings study last summer.

The state saved $42.5 million in 2010 alone, an average return of $5.85 in avoided Medicaid costs for prenatal, delivery and first year of infant care for every $1 spent on the program.

More important, Hickenlooper said, the initiative “has helped thousands of young Colorado women continue their education, pursue their professional goals and postpone pregnancy until they are ready to start a family.”

According to program supervisor Greta Klingler, Illinois, Nevada, New Jersey, New York, Ohio, Virginia and Wisconsin have asked Colorado to share its techniques and lessons learned. Illinois is already adopting some of Colorado’s methods in a statewide Medicaid program for unwanted pregnancy prevention, she said. The U.S. Centers for Disease Control and Prevention is also seeking more details from Colorado.

Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy, pointed to the promise of state-based programs that rely on low-maintenance, highly effective methods of contraception coupled with good counseling.

“We’ve made progress, but if we’re going to continue making progress, efforts going forward will have to be as innovative and up-to-date as possible,” Albert said.

But Colorado’s program will end this June when its private grant runs out, unless lawmakers approve state funding to keep it going for another year. A $5 million funding bill was introduced this month with bipartisan sponsorship, but it won’t necessarily be an easy win, especially in the Republican-led state Senate.   Continue reading

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7 Reproductive rights issues to watch in 2015

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By Nina Martin ProPublica

Abortion Knoxville-march-for-life-2013-3To say abortion opponents are feeling fired up in 2015 would be a massive understatement.

In their first week back at work, congressional Republicans introduced a sweeping prohibition on abortions after 20 weeks of pregnancy (H.R. 36, the Pain-Capable Unborn Child Protection Act), as well as bills that would ban sex-selective abortions, target funding for groups like Planned Parenthood, require abortion providers to have hospital admitting privileges, and let doctors and nurses opt out of providing abortion care, even in emergencies.

In the states, where the 2014 elections gave Republicans control of two-thirds of state legislative chambers, incoming lawmakers also have supersized their abortion agendas.

But abortion is just one issue on the minds of activists focused on reproductive rights. There’s also birth control, conscience clauses and personhood. Here are seven key trends and themes to watch for this year.

1. A New Wave of Abortion Restrictions

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Intrauterine devices and other long-acting contraceptives gaining popularity

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A diagram showing a hormonal IUD in the uterusBy Michelle Andrews
KHN

Though they continue to be overshadowed by less expensive, less effective birth control methods, long-acting reversible contraceptives such as intrauterine devices are gaining ground, according to an analysis of recently released federal data.

Nearly 12 percent of women who used contraceptives between 2011 and 2013 used IUDs or hormonal implants, according to a Guttmacher Institute analysis of data from the federal National Survey of Family Growth.

That made these long-acting products the third most popular form of reversible contraception, behind birth control pills (26 percent) and condoms (15 percent).

The use of long-acting forms of contraception has been increasing steadily, from 2.4 percent in 2002 to 8.5 percent in 2009, according to Guttmacher.

Long-acting contraceptives don’t require women to remember to use birth control every day or whenever they have sex.

That makes them one of the most effective forms of contraception, preventing pregnancy in more than 99 percent of cases. IUDs last for up to 12 years, depending on the type, while hormonal implants protect against pregnancy for up to three years. Continue reading

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