Archive for the ‘women’s health’ Category

Maryland setting a trend for other states in contraceptive coverage

August 20, 2018

Maryland Contraception Equity Act

The Maryland State legislature made history when in 2018 they passed the “Maryland Contraception Equity Act” (MCEA), This law protects the contraceptive rights of Maryland women and their partners from insurance companies’ prior restrictions on reproductive converge. The law enshrined some of the protections of the Affordable Care Act so as to protect women even if the ACA were to be repealed.

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Source: Mirena

Groups such as NARAL1 and Planned Parenthood support this law because the law reduces cost barriers to services and medications and therefore eases access. Under the law, all reproductive medications and services are covered equally and without restrictions from insurance companies. Other state legislatures should follow Maryland’s lead and pass this sort of law to improve the reproductive rights of women and their partners.

 

One of the most powerful provisions of this law is that insurance payers now fully cover both male and female sterilization—and charge no co-pay to patients. The coverage of male sterilizations is new and previously there was an additional charge to the patient. When a co-pay is present patients may not proceed with the service due to high cost. Additionally, vasectomies, which are an outpatient procedure, are safer and more cost effective for a male than female permanent sterilization.

In addition to the coverage of sterilization, health insurance companies now also cover, long acting reversible contraceptives (LARC), IUDs and implants, with no co-pay or prior authorization. The removal of prior authorization eases access to these medications by decreasing office visits and up to weeks of wait time, thus improving patient compliance.

MCEA allows providers to prescribe a 6-month supply of contraceptive methods, instead of month-by-month dispensing that insurance previously covered, which provides convenience and improves compliance. Lastly, the Maryland law requires payers to cover over-the-counter medications such as Plan B, therefore the cost is not shifted to the woman for this emergent pregnancy prevention.

The Maryland law is even more important in light of the many recent troubling threats to women’s recent reproductive health. One example, is Judge Kavanaugh who may be added to the Supreme Court and is thought to be a threat to Roe v. Wade. Therefore, it is more important than ever that a woman’s reproductive rights are protected. We know these laws work as unintended pregnancies are reduced with the use of no-cost contraceptives and the most effective contraceptives2. A woman should be in control of her reproductive rights and plan her family by choosing the contraceptive option that best fits her lifestyle. State lawmakers should stand with women and pass common sense laws that protect women’s reproductive rights.

1 NARAL: https://www.prochoiceamerica.org/state-law/maryland/#family-planning-insurance

https://journals.lww.com/greenjournal/Fulltext/2012/12000/Preventing_Unintended_Pregnancies_by_Providing.7.aspx

 

 

 

Rwanda flies to the future of healthcare

August 19, 2018
Technology Review

Source: Technology Review

In Rwanda, drones are increasingly being utilized to deliver essential medical supplies to remote hospitals, cutting the average procurement time from the nearest major medical center from four hours down to 15 minutes. Employing drones, through a partnership with Zipline, to deliver medical supplies to underserved and remote areas represents an exciting opportunity to address Rwanda’s unique healthcare challenges. Using drones serves the interests of rural communities by enabling medical personnel to access life-saving treatments and connecting them to transfusion centers in a timely manner and with the ease of ordering with only a smartphone.

Technology Review

Source: Technology Review

While drones seem like a win-win for local medical organizations and international humanitarian organizations, the use of drones in Rwanda has some unanswered questions. Critics of drone technology question why authorities have invested so much money into drone technology while basic infrastructure, including roads and ambulances services are wanting. In addition, suppression of dissent and violation of basic human rights has become increasingly common in Rwanda. Neither the Rwandan government, nor Zipline, have revealed how much the project collaboration costs, raising suspicion further. Drones are also linked with concerns over surveillance; many populations are skeptical of their presence routinely overhead. Nonetheless, the Rwandan Ministry of Health and local hospitals remain supportive of the technology. Access to blood products helps rural hospitals treat post-partum hemorrhage, which is a significant cause of maternal mortality in Rwanda, where maternal mortality rates are 20 times higher than in the United States.

Time

Source: TIME

It is in the best interest of local communities in Rwanda, the national government, and international aeronautical organizations to encourage the use of drones to deliver medical equipment. Using lessons learned in Rwanda will aid the development of infrastructure for unmanned systems in other locations impacted by natural disaster or other emergencies. Establishing rules and regulations for the use of unmanned aircraft systems is a crucial first step in the development of this innovative and life-saving delivery system. Rwanda’s embrace of drone delivery to ensure every member of its populace has access to essential medicines within 30 minutes should be supported and replicated by international agencies.

Abortion legalization in Argentina: a missed opportunity.

August 19, 2018

Worldwide, it’s estimated that around 38% of the 210 million pregnancies occurring every year are unplanned, and of these, 22% end in abortion. Taking into account the socioeconomic and individual factors that may decrease the effective contraceptive’s use, and the inherent failure rate that every contraceptive method has, there will persist some level of unplanned pregnancies, and thus, the need for abortion. However, the capability that a women has to terminate a pregnancy legally depends on the country where they live; in those where abortion is legally restricted, it’s more common that women would seek untrained providers or undergo procedures in unsanitary conditions. Therefore, maternal mortality in related to unsafe abortion is generally high where abortion is illegal; estimates of abortion-related deaths range from 60,000 to 100,000 each year.

In Latin America, the situation is even more challenging, since 52% of the 18 million pregnancies courting each year being unplanned, with 23% ending in abortion. Furthermore, abortion laws in Latin America are some of the most restrictive around the world. Only Cuba, Uruguay and Guayana have legalized abortion; in the rest of the region, there is a handful of countries that have made some exceptions to bans on abortion (Figure 1).

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Figure 1. (Image source)

In Argentina, abortion has constituted a crime since the late nineteenth century. In 1922, the penal code provisions on abortion were amended to allow for three exceptions (life-threatening condition, rape and pregnancy in a mentally disabled woman). An estimated of 500,000 abortions occur every year in Argentina, representing approximately 40% of the total pregnancies. The legalization of abortion in Argentina was considered largely a closed topic until the lower house of Congress, passed a measure legalizing abortion (decriminalize the abortion and allow the procedure during the first 14 weeks of pregnancy) in June 2018. Nonetheless, on August 9th, 2018, the Senate voted and continued to banned abortion in Argentina through a very narrow voting results – 38 against legalizing abortion and 31 in favor. It’s thought that one of the main reasons to continue banning Argentina is due to the strong catholic background of the country. However, the possible legalization of abortion strengthen an activist movement in Argentina and many countries of South America under the hashtag #NiUnaMenos,  recognized as the green wave (Figure 2A), increasing the awareness of how the longstanding ban on abortion was contributing to the deaths of so many women and girls and public pressure to legalize it (Figure 2B).

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Figure 2: A. Feminist activists from the #NiUnaMenos march for legal and safe abortion.  B. Supporters of the bill reject the Senate’s voting. (Image Source A & B).

If countries, like Argentina, in which the abortion is permitted on very strict circumstances, have the will towards legalization of abortion, multiple actions on different fronts are required including expanded contraceptive services, educational interventions and legislative reforms. Legalization of abortion have proven to have beneficial effects in other developing nations around the world. Beyond religious believes or political perceptions, banning abortion not only jeopardizes the life of women but also removes their right to decide what’s best for their future. In the absence of any action or change, there will continue to be millions of women exposed to the risk of prosecution, disability and death due to their decision for abortion.

Domestic Violence & Firearms

August 19, 2018

Gun ownership and domestic violence pose a deadly and ongoing threat against women in the US. In the US, a woman is killed by an intimate partner with a gun every 16 hours. As seen below, women in the US are 16 times more likely to be murdered with a gun than in peer countries. Abused women are five times more likely to be killed by their abuser if the abuser owns a firearm. Additionally, most mass shootings in the U.S. are related to domestic or family violence as shooters killed intimate partners or other family members in 54% of mass shootings from 2009 to 2016.

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Making matters worse, the Violence Against Women Act, which directs the national response to crimes of domestic violence (grants for law enforcement training, victim services, National Domestic Violence Hotline) will expire at the end of September if lawmakers do not reauthorize it. The 2018 bill provides law enforcement with additional tools to remove firearms from domestic abusers, which is vital to impact this ongoing issue. If the bill is not passed, it will increase the current risks and danger to women across the US.

Federal laws state that if a domestic violence survivor has a permanent restraining order against their abuser that the abuser can’t own or buy a gun. However, this restriction is not enforced well on a state level, leaving women at risk to their abusers. Although there is immense pushback from the NRA (National Rifle Association) and private gun show organizers against any further restrictions or enforcement of existing federal gun laws limiting ownership for domestic abusers, it is clear that action must be taken now to limit access to firearms for domestic abusers. The government needs to make sure that federal laws are strictly enforced by the states and that the state police departments are properly prepared while also providing the support to domestic violence groups and resources so that domestic violence victims can receive the support they need.

Promoting Breastfeeding in California

August 19, 2018

 

Breastfeeding is recommended as the normative standard for feeding an infant due to associated health and economic benefits to mothers and infants. The American Academy of Pediatrics, International Institute of Medicine, and World Health Organization recommend exclusive breastfeeding for the first six months of life and continuation of breastfeeding with complementary foods for the first year, or for as long as mutually desired by the mother-infant dyad.

 

The Healthy People 2020 goal is to increase breastfeeding initiation rates to 81.9%, exclusive breastfeeding until six months to 25.5%, and breastfeeding until one year to 34.1%. The 2016 CDC Breastfeeding Report Card shows California has met the goal for breastfeeding initiation at 90.2%; however, exclusive breastfeeding rates for 6 months significantly drops to 24.8%, below target.

 

 

Women with workplace support are twice as likely to report exclusive breastfeeding at three months than women without accommodations. While progress in workplace breastfeeding support in California has improved from 52% in 2011 to 66% in 2016, racial and socioeconomic disparities persist. Women with lower household income or non-English primary language are less likely to have access to accommodations. Black (59%) and Latina (53%) women are less likely to receive workplace support compared to White (76%) and Asian (74%) women.

 

The Assembly Health Committee passed the bill, Assembly Concurrent Resolution (ACR) 234, which proclaims August 2018 as Breastfeeding Awareness Month in California. ACR 234 encourages major stakeholders, including the California Department of Public Health, California Women, Infants, and Children Association, and California Breastfeeding Coalition, to collaborate and explore new measures to improve access to breastfeeding support. ACR 234 will also continue California’s movement to reduce barriers to initiate and sustain exclusive breastfeeding.

 

We advocate for the above stakeholders to continue to support ACR 234 and to take action on the following issues:


  • Developing programs that raise awareness and provide support for exclusive breastfeeding until 6 months to meet the Healthy People 2020 goal
  • Implementing breastfeeding-friendly policies in hospitals, schools, and workplaces; and providing timely, culturally-competent, quality breastfeeding support
  • Eliminating existing racial and socioeconomic disparities in breastfeeding support by increasing funding toward targeted group efforts

 

 

 

The US Department of Health and Human Services Title X Program Funds Family Planning Services – What if the Trump Administration Changes That?

August 18, 2018

The abortion “debate” is a political hotbed. Regardless of where you stand, preventive health services provided by the national Title X grant program are undeniably good for public health. According to ACOG, “Four million Americans rely on Title X to access contraception and other essential care, such as cancer screenings, STI testing and treatment, and well-woman exams… After years of progress reducing unintended pregnancy rates—bringing our nation to its lowest rate of teen pregnancy—(the proposed) changes are shortsighted and hazardous. Our message to HHS is clear: keep politics out of the exam room.” https://www.acog.org/About-ACOG/News-Room/Statements/2018/Changes-to-the-Title-X-Program-Reject-Science-and-Endanger-Comprehensive-Care

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Planned Parenthood supporters demonstrate on Capitol Hill in July 2017. (Astrid Riecken for The Washington Post), retrieved August 18, 2018 from: https://www.washingtonpost.com/news/to-your-health/wp/2018/05/23/is-it-a-gag-rule-what-changes-to-family-planning-funds-and-abortion-referrals-might-mean/?noredirect=on&utm_term=.bad1e39bca3b

The changes, recently proposed by the Trump administration in an appeal to voters that oppose abortion, would do the following: 1) withhold funding from health centers that perform abortions or are affiliated with those that do and 2) prohibit health care providers from discussing pregnancy termination, providing materials that mention abortion, or referring patients to abortion providers.

The restriction to counsel a patient on pregnancy options automatically limits the ability to follow the evidence-based clinical guidelines recommended by the American College of Obstetrics and Gynecology, known as three option counseling—continue pregnancy and parent, continue pregnancy and seek adoption services for the child, or terminate the pregnancy.

In my home city of Baltimore, almost 1 in 3 women rely on Title X for family planning services. Thanks to this funding, unplanned pregnancy rates have fallen by 61% between 2010 and 2016. Many of the 23 sites in Baltimore that receive Title X funding would be at risk for closing their doors if the proposed rules were adopted. https://www.wmar2news.com/news/state/proposed-title-x-changes-could-affect-health-services-funding-in-baltimore-city-delegation-warns

The Baltimore City Health Department officials who have denounced these proposed changes have encouraged those of us who care for patients, or otherwise have a stake in women’s health care, to make our voices heard, to hopefully stop legislative action on the proposed changes. Comment here: https://action.aclu.org/petition/no-gag-rule

Leana Wen twitter post pic

 

 

Human papillomavirus vaccination crisis in Japan

August 16, 2018

Human papillomaviruses (HPV) are associated with the development of cervical cancer, and the mortality and incidence of cervical cancer is increasing in the last decade among Japanese women. Two prophylactic vaccines, a bivalent vaccine and a quadrivalent vaccine, were licensed in Japan, and in 2011, the Japanese Ministry of Health, Labor and Welfare (JMHLW) recommended a fully financed HPV vaccination policy of girls aged 12 to 15. However, in 2013, several cases of “vaccination-associated neuro-immunopathetic syndrome” were reported (although it was not based on scientific evidence), and it was lionized by the media. After these events, the JMHLW suspended the policy and stopped promoting the vaccine usage, leading to drastic decrease in vaccination coverage from 70% to less than 1% (figure).

Uptake rates for the human papillomavirus vaccine in Sapporo, Japan, as of March, 2014. Lancet. 2013;382:768

Uptake rates for the human papillomavirus vaccine in Sapporo, Japan, as of March, 2014. Lancet. 2013;382:768.

 

Many stakeholders support the resumption of HPV vaccination policy. For instance, Japan Society of Obstetrics and Gynecology (JSOG) approved of the resumption of HPV vaccination policy in 2015. And in 2017, JSOG and other organizations proposed a joint statement calling for the prompt resumption of the HPV vaccine policy. The statement also demanded scientific research for “HPV vaccine-related side effects” claimed by the All Japan Coordinating Association of HPV Vaccine Sufferers . In fact, several members of this organization demanded compensation from the government and vaccine manufacturers and instituted proceedings in Tokyo court.

The governmental action has been stagnant for fear of harmful rumors and misinformation by opposing organizations and media; however, we firmly support the resumption of HPV vaccination policy in Japan because it is one of the most effective primary prevention methods to combat the scourge of HPV-related cervical cancer and it would save future healthcare cost.

The result of the Nagoya study, showing no association between HPV vaccines and reported post-vaccination symptoms, was a ray of hope for the JMHLW to advocate for the resumption of the HPV vaccine policy.

We make two requests to the JMHLW: (1) providing correct information of HPV vaccines and prevent the public from being deceived by the flood of disinformation; (2) supporting scientific research for “HPV vaccine-related side effects.”

 

Intimate Partner Violence in Alaska: “A Disease of the Outside People”

August 15, 2018

Reports from the CDC reveal that 8.5 million women in the United States experience Intimate Partner Violence (IPV) in a lifetime, with  some episodes occurring before the age of 18. Ninety-nine percent (99%) of IPV against females in the United States are male perpetration against female. The Federal Bureau of Investigation and CDC data shows that 23.2% of all violence against women and over 50% of female murder victims in the USA were from intimate partners, with ethnic minorities and immigrants reporting the highest incidence, overall. Even more alarming are the rates in Alaska which are reported to be the highest in the USA, with 50% of all women living in Alaska reporting IPV and 75% of Native American and Alaskan Native women reporting spousal abuse. Furthermore, in Alaska, “72% of all murder-suicides involve an intimate partner and 94% of the victims of these murder-suicides are female”, with over half of these homicides carried out by a gun. Negative health outcomes associated with IPV range from physical injury (chronic pain, disability and sexual transmitted infections) to long-term psychological problems.

Lack of comprehensive, early, and integrated IPV education programs for children in Alaska, lack of knowledge regarding traditional beliefs, substance abuse and health disparities regarding mental health care for Native American and Alaskan Natives may contribute to the high prevalence of IPV in Alaska. Some local agencies offer IPV prevention outreach and advocacy in Alaska, however, they lack comprehensiveness and early education intervention.

Fourth R is a mandatory school program that helps to provide relationship skills for youth related to bullying, violence and substance abuse in the school systems across Alaska.  We believe the next step to “R” (relationship) value is the integration of IPV prevention within “Fourth R” programs in our schools. An integrated program, if approved by local and state legislators, focused on IPV awareness and prevention measures may provide a key to break free from “The Disease of the Outside People” within the Native American and Alaskan Native population and to lower the overall incidence of IPV within the State of Alaska.

by L Maria Walton, Fawaz Abdul Raheem and Semirat Azeez

The Teen Mom Trend: Effective Sex Education

March 11, 2018

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In 2015, 22.3 of every 100 babies were born to women between the ages of 15-19 in the US. While this rate is gradually decreasing, teen pregnancy is still a serious issue for many reasons. Teen pregnancy and childbirth accounted for an estimated $9.4 billion in excess costs to United States taxpayers due to increased foster care, increased incarceration rates for children born to teen parents, and lost tax revenue due to lower educational achievement and lower income for teen mothers. Additionally, teen mothers have higher high school dropout rates; only 50% of teen mothers receive a high school diploma before the age of 22. This is in contrast to a rate of 90% for women who do not give birth during high school years. Furthermore, the children of teen parents are more likely to have lower educational achievement, have more health problems, be incarcerated, face unemployment, as well as continue the cycle and give birth as a teenager. Not only does this signify a serious economic burden on taxpayer money for healthcare, jails, foster care homes, and welfare, but it is also a serious public health issue.

Preventing teen pregnancy has wide support, as it is one of the CDC’s seven top priorities in public health. However, while agreement that teen pregnancy is a serious, widespread issue in the US, agreement on what to do about it is not. Because the issue of free birth control is complicated and would require years to pass as a bill in the federal government, implementing an educational policy that can be put to use much more quickly is the best option. A successful program would be adopted in all US public schools to increase awareness and promote safe sex practices in hopes that teen pregnancy rates reduce. The program will be made available to private schools, but as most private schools are religious there may be resistance –because concerns have been made that sex education should be the right and responsibility of the parents. Therefore, the public school sex education system will be the main target. School boards that may be hesitant to adopt a federally regulated sex ed curriculum, should be reminded that their main concern should be on lowering teen pregnancy and keeping girls in school. While sex education does exist in some public schools, it is difficult to regulate the curriculum and the education is focused primarily on abstinence. A new program should  be put in place to provide a more well rounded sexual education that is relatable and up to date on current teenage culture. This will help to increase the chances of teenagers receiving and internalizing the message of safe sex practices. Since 1997, the US government has spent billions of taxpayer dollars investing in abstinence only programs which have been “proven ineffective” and “censor or exclude important information” that could only help adolescents make better decisions about their own sexual health. In 2004, a report released by the US House of Representatives Committee on Government Reform showed that 80% of the most popular federally funded abstinence only education programs “use curricula that distort information…misrepresent risks of abortion, blur religion and science… and contain basic scientific errors.” Furthermore, 88% of youth participating in virginity pledges broke the pledge and had sex before marriage. This demonstrates the need to target the government to reform the sex education system in order to address the severe issues associated with the current sex education curriculum. Societal beliefs and practices have changed in regards to sex, especially amongst the younger generations. Abstinence is considered to be an outdated belief that teenagers most likely will not follow. On the other hand, studies on comprehensive sex education reveal significant effectiveness. Sex education programs funded by the National Campaign to End Teen and Unplanned Pregnancy lead to 40% delayed sexual initiation, 60% reduced unprotected sex and much more. Having a comprehensive sex education program that will include abstinence, but emphasize attainable and current safe sex practices is the only option that can be implemented quickly and has seen success amongst the target audience. Thus, a federally funded and regulated comprehensive sex education program would significantly reduce the rates of teen pregnancy, and thus reduce the burden on American taxpayers, as well as better the quality of life for teens and families across the country.  

Abortion reform in Lao PDR. What next?

March 10, 2018

The global burden of unsafe abortion

Globally, 25 million unsafe abortions occur each year. Unsafe abortion accounts for up to 22, 000 maternal deaths world-wide and approximately 6.9 million hospital admissions, at a cost of $US533 million.

Consequences of unsafe abortion in the developing world

Restrictive abortion laws and policies continue to hamper efforts to reduce maternal death and disability. Restrictive abortion laws and policies significantly reduce the proportion of safe abortions, but do not reduce the total number of abortions. Reforming abortion law and policy can be a catalyst for preventing unsafe abortion.

 

What is happening in Lao PDR?

Significant abortion reform has occurred in Lao PDR over the past two years. Prior to 2016, abortion law and policy was largely unclear, leading to restrictive interpretations and limited access to safe abortion services. In 2016, the Prevention of Unsafe Abortion Guideline was released, which clarified many aspects of abortion management, including eligibility criteria, procedural standards and post-abortion care.

Whilst the release of the Guideline removes many legal and policy barriers to service reform, there is little evidence that such reform is underway. To date, no data has been released about the number of abortions performed or complications. Further, there is an absence of coordinating policy to facilitate effective implementation of services contained within the Guideline.

 

What next?

Lao PDR is embarking on the next phase of health sector reform, as outlined in the National Strategy and Action Plan for Integrated Services on Reproductive, Maternal, Newborn and Child Health 2016 -2025. This is a key opportunity to ensure that abortion services contained within the Guideline are implemented to their full extent. This should include the development of an Action Plan, with:

  1. Specific, measurable targets for service delivery
  2. Mechanisms for monitoring implementation and regular review of progress
  3. Allocation of appropriate resources, including managerial staff, health workers, medications and equipment
  4. Defined roles and responsibilities for key advocacy groups including the Lao Women’s Union
  5. Defined roles and responsibilities for key development partners including Population Services International

 

Dr Jeremy Chin was part of a World Health Organization team that supported the development of the Prevention of Unsafe Abortion Guidelines in  Lao PDR in 2016.