Westside Family Health Center

Trending Women’s Health Care – Next Steps

Presented by Deb Farmer, President/CEO

Westside Family Health Center

Lunch & Learn – 05.16.12

at Mt. Olive Lutheran Church, Santa Monica

First, Happy National Women’s Health Week! Sponsored by the U.S. Department of Health and Human Services' Office of Women’s Health, National Women’s Health Week is meant to empower women to make their health a top priority.

As far as I can tell, there is no federal Office of Men’s Health. In fact, when I Googled Office of Men’s Health, a section came up under womenshealth.gov. Interesting, isn’t it?

Back to the Office of Women’s Health and this week – empowering women to make health their own priority. That is why we are here today. How do we empower women, what steps do we take, how do we influence people of power to quit messing around with our health, our bodies and our very survival?

A very wise person said to me the other day – we have to stop separating birth control/contraception issues from abortion. It’s all reproductive health. Call it what it is – reproductive health. You know, they are right. It is all reproductive health and the most recent attacks on both contraception and abortion show that it’s not just one or the other, but both.

Since our March Lunch & Learn, a slew of legislation has been introduced that affects women’s reproductive health. This is on top of the laundry list of truly horrid, misogynist and “twilight zone” legislation that I talked about two months ago. Here are some examples:

Kansas Governor Sam Brownback signed into law an expanded conscience clause in which “religious” workers can refuse to assist women if they believe a woman may be terminating a pregnancy. Keep in mind many believe birth control and emergency contraception cause abortion, not prevent conception. The wording is such that it would allow refusal of medications simply because they relate to abortion. Already in Idaho a pharmacist refused to supply medications to a woman who was heavily bleeding because he believed that her bleeding was caused by abortion. He was not disciplined in any way. Nurses at a New Jersey hospital have refused to do intake of women scheduled for termination. And, a bus driver was fired for refusing to take passengers to a Planned Parenthood clinic, even though it was on his route.

In Georgia, a bill has been introduced banning abortion after 20 weeks post-fertilization. Once the fetus is past the 20-week mark, every effort must be made to save the fetus’ life. So, if a woman comes in at 21 weeks with an unviable fetus – meaning it would not live – the physician would be required to do a C-section because according to the Georgia legislator “you deliver the baby in the way that’s most likely to save both lives.” This legislator, with no medical training, doesn’t seem to care about the living mother.

On July 1, women in Mississippi will soon lose all access to safe, legal abortions due to legislation passed requiring doctors performing abortions to obtain hospital admitting privileges. Opponents of the bill were quoted as saying in jest, “Well, the poor pitiful women that can’t afford to go out of state are just going to start doing them at home with a coat hanger.” A legislator's reply: “But hey, you have to have moral values.” Who knew that driving desperate women to take drastic measures is worth it for “moral values”. The original intent of the bill, according to early anti-choice sponsors, was to stop backdoor abortions. Apparently, clinics are backdoor operations.

Again, in Kansas, legislation was introduced forbidding the University of Kansas medical school from training for abortion care. This has been temporarily derailed by the anti-choice Speaker of the House because “we must protect accreditation of our flagship medical center,” and not because the health of Kansas women must be protected. Remember, Kansas is where Dr. George Tiller was gunned down in church by an anti-choice fanatic.

Alabama has introduced legislation that would prevent medical abortions – a very safe, easy method in early terminations. Remember, medical abortions can only be done in the first 9 weeks of pregnancy.

In Missouri so many regulations targeting medical abortions are being introduced that no doctor may be able to meet them. The laws, known as TARP (Targeting Regulation of Abortion Providers) were introduced originally in Virginia and have expanded westward. In Missouri, a physician would have to perform a physical exam of the patient 24 hours in advance of providing the medication for a medial abortion -- not a nurse practitioner or any other medical professional but a physician. The physician would have to have admitting privileges at a local hospital and privileges to intervene with surgery, if necessary. They would have to carry additional medical malpractice insurance of $1 million per occurrence and $3 million annually for injury or death of a child born alive after an attempted medical abortion. Again, that’s the first 9 weeks of pregnancy. TARP laws create so many barriers that women will wait to have an abortion resulting in higher risk and cost. As a sidebar, I understand miracles but it would take more than a miracle for a 9-week old fetus to survive.

And, just so ya’ll don’t think all this just happens in my home region – the South – I bring you other news:

As part of a business tax credit bill, legislators in New Hampshire passed a 24-hour waiting period on abortions. It specifies a series of steps a doctor must take 24 hours before an abortion is scheduled.

In Grand Rapids, Michigan a failed City Council candidate wants women to provide documentation to the City that an abortion was needed to save the mother’s life or that the pregnancy was the result of rape and incest. I guess a woman’s privacy isn’t worth much in Grand Rapids.

Just last week, the governor of Arizona signed a bill into law that bans any state funding from going to Planned Parenthood – the state’s largest provider of basic gynecological care and family planning services with more than 70,000 patients.

Finally, in Arizona, Governor Jan Brewer has signed into law a measure that would allow some religious employers to opt out of covering contraception as part of their healthcare plan. It’s about religious freedom, not a woman’s right to choose contraception. Oh, I believe Viagra is still covered….

We also have “wrongful birth” bills being considered in several states. This legislation, if passed, would allow physicians to lie to their patients by withholding information to prevent them from having an abortion. Six states already have these bills with Kansas and Arizona considering them.

Then we have what’s happening or not happening to our young people.

Tennessee’s Governor Bill Haslam has signed into law a sex education bill that disallows “gateway sexual activity.” While Tennessee’s programs already focused on abstinence, apparently they weren’t enough. The trouble is no one is sure what “gateway sexual activity” actually is. Isit kissing? Is it touching? Where can you touch? Where can’t you touch? Oh, to be a teacher in Tennessee…

The Obama Administration recently added the Heritage Keepers abstinence-until-marriage curriculum to a list of effective sexuality education programs qualified for federal funding. The Heritage Keeper curriculum is not about sex, it’s about heterosexual marriage. It equates premarital sex with high divorce rates and infidelity. It warns young women to wear modest clothing to “ward off lustful thoughts” and assigns students wedding planning homework.

Why is this important? The Guttmacher Institute, a reproductive health think tank, has reported that the more young people know about sexuality, the more likely they are to postpone their first sexual experience (by about 14 months) and the more they know about contraception, the less likely they were to have unprotected sex.

Abstinence-only education has been found to teach that condoms have a 30% rate of failure, that birth control pills cause cancer and that pregnancy can result from touching each other’s genitals. Is it any wonder that 60% of young adults don’t understand the effectiveness of birth control? In a recent Guttmacher survey, 40% of young people said birth control really didn’t matter – when your time comes to get pregnant, you’ll get pregnant.

This week we have heard a lot about the reauthorization – or not – of the Violence Against Women Act (VAWA). One out of every four women has been affected by domestic violence, dating violence, sexual assault and stalking. Of particular concern is the fact that certain women are not protected: immigrants, LGBT community and Native American women. If an immigrant woman filed for relief as a victim of domestic violence, her abuser would be notified of the filing and possibly her address. It will also disallow a path of citizenship through U-visas for immigrant women. The section of the law that would bar discrimination against LGBT individuals was totally omitted. Finally, Native American tribal authorities were not given criminal justice authority over non-Native American offenders who commit crimes on tribal lands.

Why is VAWA worth mentioning during National Women's Health Week? Violence against women affects their physical health, their mental health, their emotional health and their spirit. It simply is a women’s health issue.

So often I hear, “But Deb, this is California – nothing like this can happen here.” My reply is simple – I am sure that women across the country are flabbergasted, astounded and, in some cases, brought to their knees by the attacks of the last 18 months.

In 2011, 80 laws restricting access to reproductive health were passed and enacted in various states. Three times as many as 2010.

15 state governments – governor and the legislature – oppose abortion rights – a 50% increase over 2010.

6 states enacted deep cuts to family planning programs

5 states moved to restrict funding for providers that have anything to do with abortion.

In California, we are faced with a severe budget crisis and health cuts are proposed under the guise of health payment reform. Provider payment cuts are being proposed for Medi-Cal yet California already has one of the lowest provider rates in the country. Why is this important? Because fewer and fewer doctors are accepting Medi-Cal patients which puts a higher burden on community health centers.

Family planning funding for low-income women and teens – one of the most successful women’s health programs in the country – may be moved out of the Office of Family Planning into the Department of Health Care Services without possible protections for all women in California. FPACT becomes part of everything else in the DHCS budget.

Make no mistake, family planning promotes strong economics for women and families. The National Bureau of Economic Research recently released a report that said the Pill was responsible for closing the gender wage gap by 10% in the 1980s and 30% in the 1990s. Reliable birth control contributes to economic development by reducing a women’s risk of dropping out of school due to unplanned pregnancy and increases a women’s time in the work force, the continuity of her career and the standard of living of women, their children and their families.

Every dollar spent on contraception saves about $4 in future Medicaid expenditures. A 2010 California study showed that for every dollar spent on Medi-Cal family planning – FPACT-saved the public sector more than $9 over the next 5 years by averting costs on public health and welfare that would have been incurred. Yet, uninsured women spend, on average, an additional $500 or more annually on birth control.

So, what’s the good news? There is some good news.

An Oklahoma judge ruled that the arbitrary restrictions on medical abortions were unconstitutional under the Oklahoma state constitution because “they are so completely at odds with the standard that governs the practice of medicine that the bill can serve no purpose than to prevent women from obtaining abortions and to punish and discriminate against those women who do.”

In Montana, a Helena district judge declared unconstitutional the state’s ban on prescription birth control coverage for teenage girls covered under the Montana health insurance program for low-income individuals. He said it ”violated the right of privacy and the rights of persons not adults set forth in the Montana Constitution.”

The biggest piece of good news is the Affordable Care Act. Women are already benefitting but let’s review the current and future benefits to women and families:

Maternity care will be required as an essential health benefit on all new health plans beginning in 2014.

Pre-existing conditions, including C-sections, breast cancer, domestic violence and sexual assault will no longer allow a plan to disqualify a woman from a plan beginning in 2014.

Well-baby and well-child care including immunizations no longer have a co-pay requirement.

Beginning in August 2012, no-cost lactation support is covered in new health plans.

Sex discrimination is prohibited in private insurance, federal health programs and the health insurance exchanges beginning in 2014. Women paid as much as 150% higher premiums than men prior to ACA.

Insurance plans will be required to cover the cost of contraceptives - no out-of-pocket costs to women.

By 2014, 10.3 million low-income women will be newly covered under the expansion of Medicaid.

If the Supreme Court undermines the ACA, women and children will lose the most. If the California budget crisis continues and the Governor’s draconian cuts are allowed, health care in California will suffer.

What are the next steps? What can we do to ensure that women are covered and protected in California and in the nation? What can we do to empower women to make their health a top priority – the goal of National Women’s Health Week?

I invite you to think of ways that we can maintain our vigilance over women’s health care actions. I welcome you to our clinic to see and hear about the work being done. Please let us know if you would like to volunteer with us. You might consider making a donation in someone’s honor or memory in support of women’s health. We will always be there for the women and families in our community. Thank you for coming today.