Many thanks to Sara Levin, MD, for passing this along.

Substantial Progress Among Higher-Income Women Contrasts with Dramatic Increases Among the Poor
 
A new analysis from the Guttmacher Institute shows that following a considerable decline between 1981 and 1994, the overall U.S. unintended pregnancy rate has remained essentially flat—about 5% of U.S. women have an unintended pregnancy every year.  However, the rate has increased dramatically among poor women, while among higher-income women it has continued to decrease substantially, according to “Unintended Pregnancy in the United States: Incidence and Disparities, 2006,” by Lawrence B. Finer and Mia R. Zolna.
 
In 1994, the unintended pregnancy rate among women with incomes below the federal poverty line was 88 per 1,000 women aged 15­–44; it increased to 120 in 2001 and 132 in 2006—a 50% rise over the period. At the same time, the rate among higher-income women (those with incomes at or above 200% of the poverty line) fell from 34 in 1994 to 28 in 2001 and 24 in 2006—a 29% decrease. Poor women’s high rate of unintended pregnancy results in their also having high—and increasing—rates of both abortions (52 per 1,000) and unplanned births (66 per 1,000). In 2006, poor women had an unintended pregnancy rate five times that of higher-income women, and an unintended birth rate six times as high.
 
Analyzing U.S. government data from the National Survey of Family Growth and other sources, Finer and Zolna found that of the 6.7 million pregnancies in 2006, nearly half (49%) were unintended. Although some unintended pregnancies are accepted or even welcomed, more than four in ten (43%) end in abortion. Unintended pregnancy rates are elevated not only among poor and low-income women, but also among women aged 18–24, cohabiting women and minority women. It is important to note, however, that poor women have high unintended pregnancy rates nearly across the board, regardless of their education, race and ethnicity, marital status or age.
 
In contrast to the high rates among certain groups, some women in the United States are having considerable success timing and spacing their pregnancies. Higher-income women, white women, college graduates and married women have relatively low unintended pregnancy rates (as low as 17 per 1,000 among higher-income white women—one-third the national rate of 52 per 1,000), suggesting that women who have better access to reproductive health services, have achieved their educational goals or are in relationships that support a desired pregnancy are more likely than other women to achieve planned pregnancies and avoid those they do not want.
 
“These data suggest that women who lead stable lives—women who are older, more affluent and better-educated—tend to have better reproductive health outcomes, while women whose lives are less stable, such as younger, poorer or less educated women, have higher rates of unplanned pregnancies, unwanted births and abortions,” said Finer. “They also show that marriage is not, in and of itself, a solution to the problems women have in controlling their fertility: In fact, poor women who are married have unintended pregnancy rates more than twice as high as those of higher-income women who are unmarried or cohabiting.”
 
In commenting on the study, Guttmacher Institute President and CEO Sharon Camp said: “The growing disparity in unplanned pregnancy rates between poor and higher-income women—which reflects persistent, similar disparities across a range of health and social indicators—is deeply troubling.  Addressing them all requires not only improved access to reproductive health care, but also looking to broader social and economic inequities.  At a minimum, however, we must ensure that all women, and particularly those who are most vulnerable, have access to the education and range of reproductive health services and counseling they need in order to plan the pregnancies they want and prevent the ones they don’t.”“

“Unintended Pregnancy in the United States: Incidence and Disparities, 2006”   is currently available online and will appear in a forthcoming issue of the journal Contraception.

For more information on the impact of unintended pregnancy on public policies and programs, see “Wise Investment: Reducing the Steep Cost to Medicaid of Unintended Pregnancy in the United States,” by Rachel Benson Gold.
###
 
The Guttmacher Institute—www.guttmacher.org—advances sexual and reproductive health worldwide through research, policy analysis and public education.

Ellen Shaffer, SF Chronicle: Domestic Violence Spotlighted

OPEN FORUM: On Women’s Health
Domestic violence spotlighted
By Ellen R. Shaffer
Her husband described the abuse: “I would hold her hostage and terrorize her.” The Kaiser patient reported how she finally decided to leave: “I’ll never forget the office visit when my physician said, ‘I’m afraid if your husband doesn’t kill you, the stress will.’ ” This week’s groundbreaking decision by the U.S. Department of Health and Human Services to require health plans to cover domestic violence counseling without requiring a co-pay will give women and their health care providers an important new incentive to call out the distress signals of abuse, and to take action.

Domestic violence is a widespread, harmful and expensive public health issue. Public awareness campaigns, advocacy groups and laws offer support and a way out, but too many individuals remain isolated and stigmatized. Every year, 2 million women experience domestic violence, more than new cases of breast cancer or deaths from cardiovascular disease. 

…Studies show that health care professionals can help to effectively break the cycle by bringing the problem to the surface and offering resources. In one study, women who talked to a health care provider about abuse were nearly four times more likely to use an intervention such as calling a support hotline. On follow-up, they reported fewer threats of violence and assaults. The majority ended their relationships with violent partners and did not re-enter an abusive relationship.

San Francisco Chronicle, August 5, 2011  p. A 14

 The Voice of the West
Founded in 1865 by Charles and M.H. deYoung
A HEARST NEWSPAPER

EDITORIAL San Francisco Chronicle and SFGate.com | Tuesday, August 2, 2011 | A9

On Federal Health Care Rules :A birth control option

Access to affordable birth control is lacking for too many American women, resulting in a high rate of unintended pregnancies. That is changing. Following a recommendation from the nonprofit, independent Institute of Medicine, the federal government said Monday that it will require insurers to drop deductibles and co-pays for FDA-approved contraception drugs and devices, including “morning after pills.”

Under the Affordable Care Act, the federal government will require health plans to cover preventive services without cost-sharing beginning next year. Preventive services, which keep us healthier and reduce long-term health care costs, are not as well used as they might be because of their cost.

Those already approved include childhood immunizations, screenings for diabetes, high blood pressure and high cholesterol, and smoking-cessation programs. But left undecided in the rollout last year of the Affordable Care Act (what Republicans derisively call “Obamacare”) was what would constitute preventive care for women.

The institute made eight recommendations (see box) and on Monday the U.S. Department of Health and Human Services announced it was adopting all eight with the amendment that religious institutions that offer health insurance could determine what contraception they would cover for their employees. The department will collect comments on the policy for 60 days.

The move to include contraception is a much-needed bow to reality long missing from the national conversation about women and public health. That discussion has fallen hostage to abortion politics to the point where ideology trumps science, marginalizing the health concerns of most women.

“We are regaining the place we deserve as full participants in policy decisions about our own health,” says Ellen R. Shaffer, director of the Trust Women/Silver Ribbon Campaign in San Francisco.

Policy debates fail to acknowledge these realities:

49 percent of pregnancies are unintended in the United States, as compared with other developed nations (e.g., France, 33 percent; Scotland, 28 percent).

63 percent of Catholics support health insurance coverage for family planning.

Affordable access to birth control reduces abortion and saves lives.

We welcome a government stamp of approval on sciencebacked public policy that improves American families’ health and economic well-being.

The federal health care reform law now requires health plans to cover without additional cost: Birth control (religious institutions may determine coverage for their employees) Screening for gestational diabetes Breastfeeding support and counseling Counseling on sexually transmitted diseases Screenings for HPV, a cause of cervical cancer.

Counseling and screening for HIV Well-woman visits Counseling to detect and prevent domestic violence

Source: U.S. Department of Health and Human Services

The new HHS rules accept IOM recommendations to cover contraception. screenings for domestic violence and 6 other services as preventive services for women (without additional co-pays) BUT allow religious institutions to determine coverage for contraception for employees.  The call announced below for Aug. 1 at 4:30 pm EDT/1:30 PDT is still on. – Ellen Shaffer

 Call to Discuss Important Affordable Care Act Announcement
Please join HHS Secretary Kathleen Sebelius, Tina Tchen, Executive Director of the White House Council on Women and Girls and Mayra Alvarez, Director of Public Health Policy in the Office of Health Reform at the U.S. Department of Health and Human Services on a conference call to discuss an important Affordable Care Act announcement.
 
WHO:                   Secretary Kathleen Sebelius, U.S. Department of Health and Human Services
Tina Tchen, White House
Mayra Alvarez, U.S. Department of Health and Human Services
 
WHEN:                 Monday, August 1, 2011 at 4:30p.m. ET / 1:30pm. PT
 
DIAL IN:                888-968-3518
 
PASSCODE:         HHS
News Release
FOR IMMEDIATE RELEASE
August 1, 2011 Contact: HHS Press Office
(202) 690-6343

Affordable Care Act Ensures Women Receive Preventive Services at No Additional Cost
Historic new guidelines that will ensure women receive preventive health services at no additional cost were announced today by the U.S. Department of Health and Human Services (HHS). Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or a deductible.
“The Affordable Care Act helps stop health problems before they start,” said HHS Secretary Kathleen Sebelius.  “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.”
Before health reform, too many Americans didn’t get the preventive health care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs.  Often because of cost, Americans used preventive services at about half the recommended rate.
Last summer, HHS released new insurance market rules under the Affordable Care Act requiring all new private health plans to cover several evidence-based preventive services like mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a copayment, deductible or coinsurance. The Affordable Care Act also made recommended preventive services free for people on Medicare.
Today’s announcement builds on that progress by making sure women have access to a full range of recommended preventive services without cost sharing, including:
well-woman visits;
screening for gestational diabetes;
human papillomavirus (HPV) DNA testing for women 30 years and older;
sexually-transmitted infection counseling;
human immunodeficiency virus (HIV) screening and counseling;
FDA-approved contraception methods and contraceptive counseling;
breastfeeding support, supplies, and counseling; and
domestic violence screening and counseling.
New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012.  The rules governing coverage of preventive services which allow plans to use reasonable medical management to help define the nature of the covered service apply to women’s preventive services.  Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost-sharing for branded drugs if a generic version is available and is just as effective and safe for the patient to use.
The administration also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services. This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception.  HHS welcomes comment on this policy.
Previously, preventive services for women had been recommended one-by-one or as part of guidelines targeted at men as well.  As such, the HHS directed the independent Institute of Medicine to, for the first time ever, conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep women healthy.  HHS’ Health Resources and Services Administration (HRSA) used the IOM report issued July 19, when developing the guidelines that are being issued today. The IOM’s report relied on independent physicians, nurses, scientists, and other experts to make these determinations based on scientific evidence.
Today’s announcement is another part of the Obama Administration’s broader effort to address the health and well-being of our communities through initiatives such as the President’s Childhood Obesity Task Force, the First Lady’s Let’s Move! campaign, the National Quality Strategy, and the National Prevention Strategy.
For more information on the HHS guidelines for expanding women’s preventive services, please visit: http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. The guidelines can be found at: www.hrsa.gov/womensguidelines/.
To learn more about the Affordable Care Act, please visit www.healthcare.gov.

Catholics for Choice, CA OWH, Speak on IOM Report

Link to KPFA Radio Show

Listen to Jon O’ Brien, President of Catholics for Choice; and Terri Thorfinnson, JD, Chief, Office of Women’s Health, Department of Health Care Services and California Department of Public Health, discuss the IOM Report: Clinical Preventive Services for Women: Closing the Gap, with KPFA radio “Livingroom” Co-Hosts Kris Welch and Ellen Shaffer, on Friday, July 22.

The show airs from 12 Noon to 1 p.m.  The women’s health segment begins about halfway through, at 12:30.  Click on the link below to listen -advance to 30 mins. using your media player :

http://www.kpfa.org/archive/id/71761

South Coast Today    National View: Good news for women’s health and pocketbooks   By Cindy Pearson and Lois Uttley
July 22, 2011 12:00 AM

The Institute of Medicine, an independent panel of doctors and health experts, has just recommended that insurance companies be told to stop charging co-pays for contraception and several other types of women’s preventive health care in any new health plans. Ending those extra out-of-pocket insurance charges will be good for women’s health and good for women’s pocketbooks.Medical experts also are urging that insurance companies end co-pays for breastfeeding supports, including rental of breast pumps and for annual well-woman exams, HIV infection screening and counseling for women experiencing domestic violence. Most of the public attention so far, though, has focused on the experts’ recommendations about contraception. No wonder, because the vast majority of women in our country have used birth control at some time in their lives.For young women and their families who are struggling in these tough economic times, a $20 or $30 co-pay can make it difficult to afford to fill a birth control prescription each month. Some contraceptive methods like IUDs, which work better for certain women, require co-pays or deductibles that can run into hundreds of dollars. It’s understandable that women facing financial stress report they use contraception inconsistently and put off family planning office visits to save money.Without affordable and reliable contraception, however, women face the risk of unintended pregnancy. In fact, half of all pregnancies in this country are now unintended. Medical experts point out that there can be serious health consequences for both women and babies from these “surprise” pregnancies. When a woman isn’t able to space pregnancies, allowing enough time between them, her risk of experiencing maternal health problems increases. This is especially true for women who have health conditions like high blood pressure or heart disease that may be exacerbated by pregnancy, problems that disproportionately affect women of color.Women whose pregnancies are not planned are less likely to receive timely prenatal care, quit smoking and begin taking adequate folic acid to promote a healthy pregnancy.When there is an interval of less than a year between births — which can happen when a woman has no family planning — the chances increase for a pre-term birth and a low birth-weight baby who will be at risk of serious complications and even death in the first year of life.The Centers for Disease Control and Prevention has cited family planning as one of the 10 great public health achievements of the 20th century precisely because it improved the health of women and their babies.But affordable contraception does more than protect women’s health. It also protects a family’s economic security by enabling women to have children when they are able to support them. That’s why the American public strongly supports family planning services — with 84 percent of those polled in June by Lake Research Associates citing contraception as an important preventive health service.We urge the Department of Health and Human Services to adopt the recommendations of the Institute of Medicine in full and require that new insurance plans remove co-pays and extra charges for family planning and contraceptives. It will be a historic step for women’s health and the economic well-being of families across America.

National View: Good news for women’s health and pocketbooks  SouthCoastToday.com

Cindy Pearson is executive director of the National Women’s Health Network. Lois Uttley is president-elect of the Public Health Association of NYC. They are co-founders of Raising Women’s Voices for the Health Care We Need

 Religious Coalition for Reproductive Choice, Reverend Dr. Carlton W,. Veazey, President and CEO 

We are on the verge of a tremendous stride forward in women’s reproductive health.
 
Today, a panel of health experts recommended that women be able to get their birth control prescriptions filled without a co-pay or deductible. You and I have advocated prayerfully and constantly for improved access to contraception for the millions of women, especially young women and lower-income women, who struggle every day to afford prescription birth control. Now, after a year of research and debate, the Institute of Medicine’s independent experts have agreed with us that birth control is a cornerstone of preventive health care for women and must be fully covered by health insurance under the health care reform law.
 
The ability to plan pregnancies is so important that RCRC considers it a moral value and a matter of social justice. Research and our own family experiences confirm that family planning helps to build strong families, protect the health of women and children, reduce child and spousal abuse, and prevent unwanted pregnancies and reduce the need for abortion.
 
But opponents of comprehensive reproductive health care – including the U.S. Conference of Catholic Bishops and the Family Research Council – are fighting this breakthrough. They ignore medicine and science and equate birth control with abortion. Our work now will focus on urging the Obama Administration’s Department of Health and Human Services to include contraceptive coverage in preventive health care and to eliminate the cost barriers that keep many American women from using birth control consistently.
 
In the weeks to come, we will be updating you on our progress and asking for your help. Please watch for our email messages and visit us on facebook. A decision by HHS Secretary Kathleen Sebelius on this and other Institute of Medicine recommendations released today is expected in August. Your voice will be critical to building support.
 
Peace and Blessings, 
Reverend Dr. Carlton W. Veazey, President and CEO

The national scourge has attacked in Oakland, CA: http://bit.ly/iyWOtN

Ask Jeff McCuen of CBS Outdoor to remove the racist billboards from our community. As we have seen from recent media coverage, they are linked to a right-wing national campaign to completely eliminate a woman’s right to choose – and of course, starting with women of color. http://bit.ly/lHaCK7

Recommendations to IOM on Prevention Services for Women CPHAN and EQUAL 

The California Public Health Association-North[1] and EQUAL Health Network[2], transmitted the following recommendations to the Institute of Medicine’s Committee on Preventive Services for Women for its consideration.  The recommendations strongly support preventive services that are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. These services address gaps that exist in recommended preventive services for USPSTF Grade A and B preventive services guidelines for women and in Bright Futures and USPSTF Grade A and B guidelines for adolescents. We highlight specific services and screenings that should supplement currently recommended preventive services for women. 

Recommendations for Preventive Services to Women and Girls

The U.S. Preventive Services Task Force recommendations fail to address any preventive reproductive health services for women, and critical gender‐specific preventive services that promote wellness, well‐being and healthy outcomes for women. We ask the Institute of Medicine Study Committee to include the following on its list of recommended preventive services for women:

1. Provide comprehensive family planning, preconception and interconception services.

a. The comprehensive range of family planning services (clinical assessment, education and counseling, method provision), prescriptions and devices are essential to health and reproductive health.

b. Preconception and interconception care are needed preventive services to ensure women are healthy when they become pregnant.

2. Provide comprehensive prenatal and post‐partum care to pregnant and parenting women.

a. Prenatal care services for all pregnant and postpartum women include case management, health education, nutrition and psychosocial risk assessments and referrals.

b. Integrate clinical activities from basic through subspecialty services as supported by The American Congress of Obstetricians and Gynecologists (ACOG).

3. Provide a comprehensive annual well‐woman visit.

a. A well‐woman visit provides preventive care and to manage gender‐based complex health needs. This would include sensitive and comprehensive preventive health counseling.

4. Routinely screen for intimate partner violence and conduct periodic assessments about violence.

a. Include an assessment of intimate partner violence (IPV), teen dating violence, reproductive coercion, IPV during pregnancy, sexual violence.

b. Screen for depression, substance abuse, and chronic illnesses.

5. Provide optimum nutrition screening and counseling along with support of physical activity.

a. Follow the Healthy People 2020: National Health Promotion and Disease Prevention Objectives13 for healthy eating and physical activity for women and adolescents

6. Routinely screen and treat eating disorders.

a. Include both nutrition counseling and behavioral health treatment to address eating disorders.

7. Promote a comprehensive range of breastfeeding and support services

a. Provide breastfeeding promotion, education and counseling services to women, by qualified individuals based on the level of intervention required, including information about breastfeeding related durable medical equipment, supplies and banked human milk.

b. Follow The Healthy People 2020: National Health Promotion and Disease Prevention Objectives for increasing breastfeeding initiation, exclusivity and duration rates.

Adapted from: Written testimony submitted to the Institute of Medicine Study Committee on preventive services for women. Sacramento: The Office of Women’s Health, Department of Public Health and the Department of Health Care Services (2011).

The California Public Health Association-North (CPHA-N) represents the diverse public health work force, community needs, and interests in Northern and Central California, provides leadership in public health in California, and initiates and supports action to meet needs or remedy problems including education and legislation. It provides opportunities for persons actively engaged or interested in the broad field of public health to share knowledge and experiences in order to achieve the primary goal of protecting and promoting public, environmental and personal health.

** EQUAL Health Network brings together partners from public health, women’s health and the public to advocate for Equitable, Quality, Universal, Affordable – EQUAL – health care. EQUAL is a project of the Center for Policy Analysis, an independent 501c3 organization working for a healthier world.