Population, Reproductive and Sexual Health
Message From the Chair
Section Chair Barbara Anderson, DrPH, CNM, FACNM, FAAN
Frontier School of Midwifery and Family Nursing, 195 School Street, Hyden, KY 41749 Phone (951) 742-8165 E-mail: email@example.com
Dear PRSH Section members,
Greetings to everyone in our Section, all 675 of us! We have a very diverse and interesting Section with an additional 50 APHA members holding secondary membership in PRSH. A very warm welcome especially to new members and to the young professionals and students in our Section! I hope to see many of you at the 138th Annual Meeting, Nov. 6-10, 2010, in Denver. The theme of the Annual Meeting this year is Social Justice, certainly a timely theme for our nation in the throes of health care reform and the promotion of reproductive health justice.
Last November I sent out a survey asking you to guide me in the direction of PRSH for this year. Thank you for your excellent responses identifying clear and consistent communication, opportunities to participate in the Section, and membership growth as priority goals. The leadership in the Section has thoughtfully reviewed your comments and has tried to shape our agenda to these goals. I’d like to give you an update of activities.
With monthly conference calls and regular e-mails to the Section, I hope I haven’t swamped everyone with too much communication! With special thanks, I would like to highlight some initiatives in our Section:
Thank you to all who have served in our PRSH Section including the Section leadership, the Section and Governing Councilors, committee and Board representatives, and Task Force leaders. Your contributions are so numerous, making the Section function on an ongoing basis. The Section is particular would like to thank Past-Chair Rebecka Lundgren for her guidance in this final year of her appointment.
Update of the website (Larry Finer) and the Section brochure (Paula Tavrow and Shonali Chondhury), and coordinating the update of the logo (Farya Karim).
An excellent 2010 program (Chair-Elect Henry Gabelnick and all of you who served as abstract reviewers).
Expansion of the program planning process to be more inclusive of Task Forces and to provide a broader base of support for the chair-elect doing the program planning. This has included asking Governing Council representatives and volunteers from the Section to assist with the program planning in the next year.
Outstanding contributions in APHA policy development and revision (Action Board representative Lisa Maldonado and all who worked with the policies).
The initiation of a competitive PRSH Student Scholarship, awarding partial conference funding for 10 students in the Section (PRSH leadership, Iris Meltzer, and especially our student representative Lisa Oakley).
Establishment of a listserv of PRSH members in academia in hopes of developing better outreach to students (Paula Tavrow).
Development of a PRSH Google listserv (Lisa Maldonado) so PRSH members who wish to join will have ready access to other Section members. We hope this will encourage communication and discussion within the Section.
This year, one of the key initiatives of APHA, in collaboration with the Student Assembly, has been to develop a mentorship program. You recently received information from both the Student Assembly and our Section requesting your participation. Current students and young professionals in public health, the health professions, law, political science, the humanities, the social sciences, and public administration (just to mention a few disciplines) are critical to the future of health care reform, health service delivery, and public health nationally and globally. Our encouragement and mentorship is an essential step in their development toward leadership. Before many years pass, we will be handing the leadership of public health to them.
Of great concern, nationally and globally, is whether there will be enough of “them” to carry forth the public health agenda. To date, our nation has failed to prepare and employ adequate numbers of public health workers to keep pace with the growing health needs of our nation. Lacking adequate numbers, including sufficient numbers of faculty in universities, ensures that public health policy and program agendas will be undermined and an inadequate workforce is a determinant of population growth, access to family planning, and the reproductive and sexual health of our nation.
Strengthening the reproductive health workforce is a vital concern now and for the future. Our Section has an opportunity to model the conference theme of Social Justice by reaching out and inspiring young professionals and students. They are our national treasures and will be our legacy. I encourage each member of our Section to touch the life of at least one young professional or student.
Barbara A. Anderson, DrPH, CNM, FACNM, FAAN
Chair, PRSH Section, APHA
It's not the load that breaks you down, it's the way you carry it.
-- Lena Horne
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Action Board Report
Board Representative Lisa Maldonado,
Reproductive Health Access Project, P.O. Box 21191, New York, NY 10025, E-mail: firstname.lastname@example.org
Developing cutting edge, evidence-based public health policy is one of APHA’s core activities. APHA members drive the policy process, and this year our Section is engaged in full force. Our Section submitted or co-sponsored the following policies this year (you can access the full policy on APHA’s website):
These policies are currently winding their way through APHA’s policy approval process: vetting by APHA’s Joint Policy Committee (JPC), public hearings prior to the Annual Meeting and, if all goes well, final approval during the Governing Council meeting in the fall.
The PRSH Policy and Advocacy Committee has been actively involved in all aspects of APHA policy development. Committee members:
There is a lot more work to be done and plenty of opportunity to get involved. We need Section members to attend the policy hearings in Denver that are scheduled for Nov. 7, 4 – 6 p.m. We also need folks to help us develop policies for 2010-2011. We have identified two policies for development: a policy supporting advance practice clinicians (APCs) as Abortion Providers and a policy against Federal Restrictions to Abortion Research.
To get involved, e-mail Lisa Maldonado, our Section’s representative to the Action Board: email@example.com
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Nominations Committee Report
Chair Rebecka Lundgren, Institute for Reproductive Health, Georgetown University, 4301 Connecticut Ave. NW, Suite 310, Washington, DC, 20008
Phone: (202) 687-7968 E-mail:
It has been my pleasure this year to put together an outstanding slate of nominations for a new group of Section leaders. This was an easy task thanks to the enthusiastic response of Section members. Thanks to all who volunteered to stand for election.
Andrzej Kulczycki, PhD
Trinity Zan, MA, BA
Larisa Beckwith, MPH, PsyD, MA
Megan Cahn, BA
Tracie Graham, MPH, BA
Kristin Mark, MS
Miriam Zmiewski-Angelova, MPH
Farya Karim, MPH
Jennifer Roller Erausquin PhD, MPH, CHES
Dan Grossman, MD
Be sure to take time to vote for our outstanding slate of nominees this year. We look forward to working with you and current officers to help us advance our Section’s work.
Thanks to all!
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Abortion Task Force Report
Co-Chairs Lisa Maldonado
, Reproductive Health Access Project, P.O. Box 21191, New York, NY 10025 E-mail: firstname.lastname@example.org and Diana Romero, Urban Public Health Program, Hunter College, City University of New York, 425 E. 25th St, Box 807, Rm. 714 New York, NY 10010 Phone: (212) 481-5073, E-mail: email@example.com
Access to safe and legal abortion is limited for women all over the world. The Abortion Task Force recognizes that abortion is an important component of family planning. We will only achieve reproductive justice when all women have access to all forms of birth control.
The Abortion Task Force is currently working on reframing abortion within a public health context, developing public health practice and policies that promote and preserve access to abortion and ensuring that APHA’s scientific program includes a focus on abortion public health practice, policy and research.
This year Task Force members reviewed all of our Section’s abortion-related abstracts and are sponsoring a panel at the 2010 Annual Meeting on Abortion as a Social Justice Issue.
We welcome new members. Anyone interested, please reach out to Lisa Maldonado (firstname.lastname@example.org) or Diana Romero (email@example.com).
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Emerging Reproductive Technologies Task Force Report
Co-Chairs Susan Berke Fogel,
Pro-Choice Alliance for Responsible Research, 5521 Murietta Ave., Van Nuys, CA, 91401, E-mail:
and Judy Norsigian, Our Bodies Ourselves, 5 Upland Road #3, Cambridge, MA 02140, Phone: (617) 245-0200, E-mail:
New developments in the world of emerging reproductive technologies range from the good, the bad and the ugly.
The good news is a ground-breaking decision in the litigation challenging Myriad Genetics’ patents on the BRCA1 and 2 genes and mutations that are implicated in breast and ovarian cancer. As reported in the last newsletter, the ACLU is representing plaintiffs including Breast Cancer Action, Our Bodies Ourselves and a number of individual women and renowned researchers arguing that our genes are “products of nature” and are not patentable. In an extensive decision, Federal Court Judge Robert Sweet agreed that the patents were improperly granted to Myriad. The full decision is available here http://www.aclu.org/free-speech-technology-and-liberty-womens-rights/association-molecular-pathology-et-al-v-uspto-et-al.
This case is far from over, and may be appealed. In the meanwhile, the ruling is a tremendous step forward in ending the commercial ownership of our genes, and in opening up opportunities for improving access to health care through expanded research, testing and treatment of health conditions linked to genetic predispositions. For more information about the litigation, please see the ACLU website at http://www.aclu.org/free-speech-womens-rights/aclu-challenges-patents-breast-cancer-genes-0.
Disturbing news comes in a report from the Hastings Center documenting that the fertility industry routinely disregards the American Society for Reproductive Medicine (ASRM) guidelines on paying women for their eggs. ASRM guidelines call for a general maximum of $10,000 in compensation and discourage increased payments based on particular women’s characteristics. The study, Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors by Aaron D. Levine, found that 100 SAT points is worth about $2,350 in extra compensation. This report is further evidence that ASRM’s voluntary guidelines are not sufficient to regulate the fertility industry, and may spur renewed calls for formal government regulation. http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=4549
The most disturbing news involves new attempts by some legislators to use “sex selection” as a pretext to enact onerous abortion restrictions. In Georgia, SB 529 and HB 1155, the "OB/GYN Criminalization and Racial Discrimination Act" would have: 1) prohibited abortion of a fetus based on race, color or sex; 2) penalized medical professionals for alleged “criminal coercion” of women seeking abortions and forced doctors to prove they did not “solicit” the abortion; and 3) required women to document their reasons for seeking a legally protected abortion. Tremendous advocacy efforts led by SisterSong Women of Color Reproductive Justice Coalition, Georgia Spark and SisterLove engaged and educated local, state and national advocates about this new threat to abortion rights. Their efforts resulted in stopping the legislation in Georgia, but many expect similar laws to be proposed in other states. For more information, see http://www.sistersong.net/latest_news.html.
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Sexuality Task Force Report
Chair Jenny Higgins, Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, B3, New York, NY 10032 Phone: (212) 304-5766 E-Mail: firstname.lastname@example.org
The Sexuality Task Force continues to sponsor, galvanize and highlight sexual health research, advocacy and programming. We had an energizing meeting at the 2009 APHA Annual Meeting in Philadelphia, and we are excited to convene again in Denver. Stay tuned for forthcoming information about sexuality-focused panels in November.
The Sexuality Task Force is always looking for new members, especially those who can help us make connections with other APHA Sections. If interested, please contact Jenny Higgins (email@example.com).
We wanted to share three brief sexual health updates from spring 2010.
REFUSING TO SHY AWAY FROM HEALTHY ADOLESCENT SEXUALITY
In the March 2010 issue of Perspectives on Sexual & Reproductive Health, several leading experts in the field took part in a special roundtable in which they discussed the most important priorities for sexual and reproductive health research for the next decade. In her piece, “Reframing Research on Adolescent Sexuality: Healthy Sexual Development as Part of the Life Course,” Carolyn Tucker Halpern addressed the field’s history of treating adolescent sexuality strictly as a problem, and emphasized the importance of approaching it as a developmental process, thereby helping young people make the transition from exploratory sexual activity to health sexual lives.
For more information, see http://www.guttmacher.org/pubs/journals/4200610.html
FLUIDITY IN SEXUAL VOCABULARY & TERMS
Sexual health researchers, practitioners and clinicians may need to brush up on their sexual lingo and reconsider what some clients mean when they use the term “unprotected sex.”
In recent article in Culture, Health & Sexuality, Wynn, Trussell and Foster analyzed 1,134 e-mails sent to an emergency contraception website in the United States (http://ec.princeton.edu/) over the course of one year. The range of terms used varied widely by category: e-mail authors used more than 30 terms or phrases to describe sexual acts. Writers of the e-mails also used a variety of modifiers and qualifiers when asking questions about sex (e.g., ‘We didn’t have full out sex, he just put it in and out,’ or ‘My girlfriend and I kinda had sex, I went in like twice’). People were most likely to use avoidant language in writing about sex and genitals.
Perhaps the most striking finding was the relatively large number of writers who used the term “unprotected sex” to refer to sex without a condom but with correct use of hormonal contraceptives.
The authors argue that questions about sexual practices can be reliable only if clear consensus exists about how those sexual activities are defined. Sexual health education campaigns must take into account the range of popular expressions that can be used to express a single concept, while simultaneously keeping in mind the variability in meaning that may be attached to a single term. Finally, clinicians need to similarly be attuned to the range of expressions that patients may use to describe their sexual lives and reproductive health.
For more information, see http://pdfserve.informaworld.com/247838_731197599_919885629.pdf.
MANY PARENTS BELIEVE TALKING TO PRETEENS ABOUT SEX IS IMPORTANT, YET FEEL UNPREPARED TO DO SO
Parents’ beliefs about the importance of talking to their children about sex may not be reflected in their behavior, according to “Parents’ Perspectives on Talking to Preteenage Children About Sex,” by Ellen K. Wilson et al., published in the March issue of Perspectives on Sexual and Reproductive Health. Participants in a series of 2007 focus groups for parents of children ages 10-12 were nearly unanimous that parents should talk to their children about sex, and 89 percent believed that talking to their child would make a difference in whether he or she had sex at a young age. However, many had not done so.
The main barriers parents reported were feeling uncomfortable (39 percent), thinking someone else would do it better (37 percent), and thinking it might encourage their children to have sex (32 percent). Other identified barriers were parents’ not knowing enough about sex, having poor communication with their children in general, being too busy and considering their children too young to talk about sex.
The authors recommend interventions that support parents in opening the lines of communication with their children, talking to them about sexuality throughout childhood and assessing what topics are appropriate at different ages. They suggest that providing parents with information about the stages of sexual development could help them understand their children’s need for information about sex even before their youngsters show signs of interest.
For more information, see http://www.guttmacher.org/pubs/journals/4205610.html.
Yours in sexual health and sex positivity,
The Sexuality Task Force
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Other Committee and Task Force Information
Erica Fishman, Minnesota Department of Health, P.O. Box 64882, St. Paul, MN 55164-0882 Phone: (651) 201-5899, E-mail: firstname.lastname@example.org
Adolescent Health Task Force
Co-Chairs John Santelli, Professor of Clinical Pediatrics and Clinical Population & Family Health, Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave., B-2, New York, New York 10032, Phone: (212) 304-5634, Fax: (212) 305-7024, E-mail: email@example.com, Iris Meltzer, Children’s Hospital Medical Center of Akron, One Perkins Square, Akron, OH 44308, Phone: (330) 543-8914, E-mail: firstname.lastname@example.org, and Susan Newcomer, DBSB/CPR/NICHD, 6100 Executive Blvd, Building 61E, Room 8B13, Bethesda, MD 20892-7510, Phone: (301) 496-1174, E-mail: email@example.com
Management and Sustainability Task Force
Co-Chairs Lisa A. Hare , JSI, 1616 North Fort Myer Drive, 11th Floor, Arlington, VA 22209, Phone: (703) 528-7474, E-mail: firstname.lastname@example.org, and Erica Fishman, Minnesota Department of Health, P.O. Box 64882, St. Paul, MN 55164-0882, Phone: (651) 201-5899, E-Mail: email@example.com
Men and Reproductive Health Task Force
Chair Paul G. Whittaker, Family Planning Council, 260 South Broad St., Suite 1000, Philadelphia, PA 19102, Phone: (215) 985-6769, E-mail: firstname.lastname@example.org
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On The Hill: International
Craig Lasher, Director of U.S. Government Relations , Population Action International, 1120 19th St, NW, Suite 550, Washington, DC 20036 email@example.com
Much has transpired on Capitol Hill and in Washington since the last Section newsletter in September — large funding increases for international family planning and reproductive health (FP/RH) programs approved and requested, significant policy changes attempted through legislation, and a presidential initiative undergoing ongoing definition.
International Family Planning Funding Boosted, But Disappointment on Permanent Gag Rule Repeal
In December 2009, Congress passed an omnibus spending bill for fiscal year 2010 containing a significant funding increase for FP/RH programs, but which dropped a Senate amendment that would have legislatively blocked a future president, hostile to family planning, from unilaterally reimposing the Global Gag Rule.
The omnibus spending package (H.R. 3288) includes six of the seven appropriations bills that had not been enacted into law by the start of the fiscal year, including the State-Foreign Operations bill that contains language on funding and policies for international FP/RH programs.
The omnibus contains a number of important FP/RH provisions, including:
Funding: The bill includes a total of $648.5 million for bilateral and multilateral FP/RH programs, an increase of more than $103 million or 19 percent above the FY 2009 enacted level and $55 million more than the President’s budget request.
Of the $648.5 million total, $593.5 million is provided to the U.S. Agency for International Development (USAID) for bilateral field and centrally-funded programs and $55 million is earmarked for a U.S. contribution to the United Nations Population Fund (UNFPA).
FP/RH programs fared well compared to other non-HIV/AIDS global health programs, which nevertheless enjoyed modest increases such as $54 million more for maternal and child health.
UNFPA: The bill contains a statutory earmark of $55 million for a U.S. contribution to UNFPA from the International Organizations and Programs (IO&P) account, which funds the U.S. voluntary contributions to all UN agencies.
The omnibus reflects President Obama’s decision to restore a U.S. contribution to UNFPA earlier in 2009.
Several restrictions governing UNFPA’s use of U.S. funds included in previous years’ appropriations bills remain. Specifically, UNFPA must maintain U.S. funds in a segregated account, none of which may be spent in China or on abortion. The U.S. contribution to UNFPA is subject to a “dollar-for-dollar” reduction by the amount that UNFPA plans to spend in China. Funds appropriated for UNFPA that are not made available to UNFPA due to the operation of any provision of law, would be transferred to USAID for bilateral family planning, maternal health and reproductive health activities.
Global Gag Rule Permanent Fix: Unfortunately, the omnibus does not contain the Senate Appropriations Committee-approved Lautenberg amendment that would permanently prohibit the President from refusing to fund foreign NGOs solely because they provide medical services, including counseling and referral, that are permitted in their country and are legal in the United States and from imposing free speech restrictions on foreign NGOs not imposed on U.S. organizations receiving U.S. foreign assistance.
The macro-level politics of the omnibus, as well as debates around domestic abortion issues and continuing political fallout from the health care reform debate, prevented FP/RH supporters in Congress from including a permanent gag rule repeal in the bill. Advocates are exploring potential strategies for securing a permanent legislative repeal, but the task will not be any easier in 2010, a congressional election year.
2011 Family Planning Budget Request Largest Ever
Although the federal budget was released on Feb. 1, final decisions on the funding for FP/RH were not made public by the State Department until the release of the congressional budget justification document for foreign assistance in early March.
President Obama’s budget proposal for foreign assistance programs in fiscal year 2011 is a major step forward in addressing the family planning needs of millions of women and men in developing nations and marks a continuation of the dramatic shift away from stagnant levels during the Bush administration.
The Obama administration is proposing $715.7 million for bilateral and multilateral FP/RH assistance — a $67 million or a 10 percent increase above the $648.5 million that Congress appropriated in FY 2010 in the omnibus spending bill. The proposed increase is especially significant in light of the difficult economic and budgetary climate.
If appropriated by Congress, the overall funding level of $716 million proposed would represent the largest amount of funding for international FP/RH programs — not accounting for inflation — ever approved. It would also reflect a $252 million — or 54 percent — increase in funding in the three years since the last fiscal year of the Bush administration.
Most of the requested FP/RH assistance — $666 million — is for bilateral programs administered by USAID, which provides family planning assistance in more than 50 countries. The bulk is requested within a Global Health and Child Survival (GHCS) account — $590 million, an increase of $65 million above current levels — and the remaining $76 million contained in other bilateral accounts, a $7 million increase above current levels.
Of the $716 million requested overall, $50 million is proposed for a U.S. contribution to UNFPA, which provides critical FP/RH care in more than 150 countries. The proposed $5 million cut from the current contribution of $55 million is the only disappointing development contained in the President’s request for FP/RH programs. The entirety of the UNFPA contribution is funded out of the State Department’s IO&P account.
In a briefing to reporters on the budget request on Feb. 1, Deputy Secretary of State Jacob Lew noted that 28 percent of the request is devoted to “efforts to meet urgent global challenges such as natural and manmade disasters, poverty, disease, malnutrition and threats of further instability from climate change and rapid population growth. These investments improve people’s lives and makes them less vulnerable to the ravages of poverty and the threat of instability that extreme poverty breeds. Improving the most basic human conditions not only reflects our values; it enhances our security. Left unmet, these conditions lead too often to conflict, instability and failed states.”
Interestingly, the Obama administration’s three highest non-security-related funding priorities in its budget request — global health, climate change, and hunger and food security — are all inextricably linked with demographic trends and population and family planning issues.
Click here for a more detailed analysis of the President's FY 2011 budget request as it relates to international family planning and reproductive health.
FY 2011 Appropriations Process
How Congressional appropriators will respond to the proposed increase in funding for international FP/RH programs remains to be seen. Fortunately, the State-Foreign Operations Subcommittees in the House and Senate, which have jurisdiction over FP/RH programs, are chaired by strong FP/RH champions — Rep. Nita Lowey, D-N.Y., and Sen. Patrick Leahy, D-Vt., respectively.
However, appropriators are likely to closely hew to the program priorities outlined in the President’s budget request, and the overall amount of foreign assistance dollars the chairs and subcommittees will have to divide may be lower than President Obama proposed, forcing difficult choices between competing programmatic and foreign policy concerns. While it remains unclear whether Congress will enact a budget resolution, the Senate Budget Committee has adopted a $4 billion cut for international affairs programs, the entirety of the reduction proposed by the committee for discretionary spending.
Advocates will again seek to attach language to the appropriations bill instituting a permanent legislative ban preventing a future President, hostile to family planning, from unilaterally imposing a Global Gag Rule-type policy.
Even though President Obama has rescinded the policy, reports from the field suggest that there is reluctance on the part of some U.S.-funded organizations to work with other family planning service providers who were unable to be funded during the Bush administration as a result of the Global Gag Rule. This reluctance is due to uncertainty as to whether those organizations will be able to continue to participate in a project over its full five-year period or will be forced to drop off if the restrictions were to be reinstated under a new administration. The concern about partnering with these affected groups will almost certainly intensify as the next presidential election approaches.
Global Health Initiative
Also released for comment on Feb. 1 was a "consultation document" on Implementation of the Global Health Initiative, the most detailed explanation of the GHI issued to date since announced last May 2009. The GHI will dedicate new resources and funding, totaling $63 billion over six years, and implement a new "business model" for the delivery of the U.S. government's global health assistance.
Among the goals and targets of the GHI are to prevent 54 million unintended pregnancies through increasing modern contraceptive prevalence to 35 percent in assisted countries and reducing the number of first births to women under 18. The document is another high-profile boost for FP/RH and the centrality of women and girls on the policy and implementation front, reinforced by a message of "coordination, collaboration, and integration" throughout.
Nevertheless, one unfortunate oversight in the consultation document is the absence of the U.S. government’s FP/RH program from the list of the key “contributions this nation has made to improve health outcomes worldwide”
In addition, the institutional arrangements and governance structure of the GHI is the largest and most critical question left still unanswered, as well as whether USAID will remain the principal implementer of U.S. overseas FP/RH activities.
In order to jump start the GHI, about ten “GHI Plus” countries that “provide significant opportunities for impact, evaluation, and partnership with governments” were expected to be named by the end of April. It is anticipated that the list of countries to be selected will drawn from those prioritized by PEPFAR, the President’s Malaria Initiative (PMI), a new food security initiative, and USAID for work on maternal and child health and FP/RH. At press time, the GHI Plus countries had yet to be named.
What You Can Do
As a constituent, voter and public health professional, your well-informed opinion on these vital programs has tremendous credibility and carries great weight with your Senators and Representative. Educate yourself and your friends, families and colleagues on the positions of your members of Congress. Please let them know what you think about any or all of these policies.
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On The Hill: Domestic
Laura Hessburg , Senior Health Policy Advisor, National Partnership for Women & Families, 1875 Connecticut Avenue, NW, Suite 650, Washington, DC 20009, Phone: (202) 238-4803, E-mail: firstname.lastname@example.org.
Health Care Reform Expands Access to Reproductive Health Services – With the Exception of Abortion
President Obama signed two bills, H.R. 3590, the “Patient Protection and Affordable Care Act,” (March 23) and H.R. 4872, the “Reconciliation Act of 2010,” (March 30) that together make sweeping and much needed changes to our nation’s health care system. Enactment of historic health care reform legislation will expand health care access to 32 million Americans who would otherwise be uninsured, make care more affordable, end harmful insurance industry policies, and improve health care quality. While the bill takes substantial and significant steps toward ensuring universal access to quality, affordable health care (including reproductive health care), this victory came at a cost – new and continued restrictions on access to abortion coverage.
On the plus side for reproductive health, the reform bill:
Allows state Medicaid programs to expand eligibility for family planning services up to the same eligibility they use for pregnant women without going through a lengthy administrative process. Most states typically provide coverage to pregnant women at or near 200 percent of poverty – levels far above eligibility for all other populations. The body of research confirming the positive impact of Medicaid family planning expansions is impressive and speaks volumes about the potential positive impact. The Guttmacher Institute estimates that establishing parity between Medicaid eligibility for pregnancy-related care and family planning services could reduce rates of unintended pregnancy and abortion in this country by 15 percent. Studies have also found that Medicaid family planning expansion has generated significant savings to both the federal and state governments. More than nine in 10 women receiving publicly funded family planning services would be eligible for Medicaid-funded pregnancy-related care if they became pregnant.
Requires coverage of preventive health care and screenings without co-payments in all new health plans. The Department of Health and Human Services is tasked with translating this requirement into coverage specifications within six months. With respect to women’s preventive health services, it requires that specifications be based on services currently recommended by the U.S. Preventive Services Task Force and those supported by evidence-based guidelines to be developed by the Health Resources and Services Administration. This provision is intended to improve affordable access to preventive health services that address women's unique health care needs such as access to family planning services and counseling.
Requires insurers offering plans in the new “exchanges” to contract with essential community providers, such as community health centers, public hospitals, HIV/AIDS clinics and family planning clinics, which serve many low and moderate-income people. This important requirement will not only allow many of the newly insured to continue to receive care from their regular health care provider but it will also help to address the substantial need for primary care providers available to serve the newly insured.
Provides $75 million in new funding for evidence-based, medically accurate and age-appropriate programs that educate adolescents about both abstinence and contraception in order to prevent unintended teen pregnancy and sexually transmitted infections, including HIV/AIDS. However, the final bill also reinstated the failed Title V abstinence-only-until-marriage program, which directs $50 million a year to states to spend on abstinence-only-until-marriage programs. Inclusion of this provision reversed a major victory celebrated by reproductive health advocates last year -- funding for the Title V abstinence-only-until-marriage program lapsed on June 30, 2009, and had not been renewed.
Requires states to extend eligibility for Medicaid to all Americans with a family income below 133 percent of the federal poverty level by 2014 (states can begin doing this now). This provision vastly expands access to comprehensive health care, including no-cost family planning services, for millions of Americans.
Health Care Reform Sobering Reality for Abortion Access
Although today, private insurance plans generally provide abortion coverage, the health care reform law actually diminishes access to health plans that include this important coverage. The law allows private health plans in the health care exchange to offer plans that include abortion coverage; however, to ensure that federal funds are not used to pay for abortion care, the bill includes an unacceptable and unworkable provision authored by Sen. Ben Nelson of Nebraska. The Nelson language requires every enrollee in plans purchased through the exchange to make two separate premium payments – one for abortion care and one for everything else – and then requires health plans to create separate accounts for the payments they receive. The Nelson provision theoretically allows health care plans to determine whether or not to cover abortion services but creates serious disincentives to providing this coverage. The arbitrary and burdensome system it creates stigmatizes abortion and is designed to deter consumers from purchasing coverage that includes abortion and health plans from offering it.
Abortion took center stage until the very end, with support for the final bill held hostage by a handful of anti-abortion rights lawmakers in the House led by Rep. Bart Stupak, D-MIich. In exchange for their votes, President Obama issued an executive order that reaffirms the Congressionally-imposed restrictions on federal funding of abortion and instructs HHS to issue guidelines within six months to ensure compliance with federal law.
Title X Family Planning Program Sees Modest Funding Increase
Congress allocated $317.5 million in FY 2010 for the Title X family planning program, an increase of $10 million from the previous year. The President requested $327.5 million for FY 2011 - another $10 million dollar increase. Any increase in funding in tough budget times is greatly appreciated, however, the increase does not come close to addressing the need. Four in 10 poor women of reproductive age are uninsured, and recent surveys have documented an increasing demand for family planning services due to the recession.
Sex Education - Two Steps Forward, One Step Back
After years of witnessing the persistent and ever-growing federal investment in abstinence-until-marriage education programs, efforts to promote comprehensive sex education began to yield tremendous returns at the end of 2009 with the passage of the Labor-HHS-Education Appropriations bill. The overdue spending bill to fund programs in FY 2010 reflected President Obama’s budget request to Congress, which called for the elimination of funding for ineffective abstinence-only programs, instead shifting funding to the new Teen Pregnancy Prevention program, an evidence-based teen pregnancy prevention initiative funded at $114.5 million. Although Congress didn’t complete action on the FY 2010 funding bill until December, it was worth the wait. In a sharp departure from recent years, the final bill defunded abstinence-only programs in their entirety and shifted funding to evidence based teen pregnancy prevention programs. The victories from 2009 were tempered somewhat by the restoration of funding for abstinence only programs in health care reform. However, the President’s FY 2011 budget requested $133.5 million for the Teen Pregnancy Prevention program, an increase of $19 million over last year. If Congress accommodates this request in addition to the new pregnancy prevention funding in health care reform, it could be a good year for comprehensive sex education programs. In March 2010, the new Office of Adolescent Health issued a request for programs to apply for funding.
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RAISE Initiative Advisor Featured in BBC Documentary on RH in DR Congo
During the summer of 2009, the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative collaborated with the BBC and Television Trust for the Environment (TVE) on the documentary Grace Under Fire. The film features the work of Grace Kodindo, Chadian OBGYN, Medical and Advocacy Advisor to the RAISE Initiative, and assistant clinical professor of Population & Family Health at Columbia University’s Mailman School of Public Health.
Voted the fourth best BBC documentary of 2009, Grace Under Fire follows Dr. Kodindo, a leading advocate for women’s reproductive health and rights, as she explores the health services available to the men, women and children affected by the fighting in the Democratic Republic of Congo (DRC). Dr. Kodindo, who has fought for many years to save lives in ill-equipped maternity wards in her native Chad for many years, hears real-life stories of a lack of basic reproductive health services and the terrible consequences of sexual violence from those caught up in the long-running conflict in the DRC.
To view an extended clip of the documentary Grace Under Fire by BBC World News visit http://www.tve.org/lifeonline. The film was be used during a number of advocacy events in the Washington, D.C. area in May and June 2010.
Grace Under Fire was produced by TVE and is a collaborative effort of the United Nations Population Fund, the World Health Organization, RAISE, CARE International and the International Rescue Committee. RAISE, a joint initiative of the Columbia University Mailman School of Public Health and Marie Stopes International, works to ensure the availability of quality comprehensive reproductive health care in situations of conflict and disaster.
RAISE Initiative Releases Results of Study of Global Policies on RH in Crises
Although progress has been made in addressing the reproductive health (RH) needs of refugees and displaced people, policy gaps persist, particularly in the areas of long-term family planning methods, emergency obstetric care (EmOC) and medical attention for survivors of gender-based violence (GBV).
To explore the global political prioritization of RH in emergencies, the Reproductive Health Access, Information and Services in Emergencies (RAISE) Initiative conducted a review of the policy environment for RH in emergencies. The review searched for language related to RH and emergencies in relevant policies and technical guidelines adopted between 1994 and 2008 by policy makers, donors and technical organizations.
Policies and technical guidelines adopted by 14 governments were examined, including those adopted by the United States of America, Canada, nine European member states, Norway, Australia and New Zealand. In addition, the policies and technical guidelines of three European Union institutions, the African Union, nine UN agencies, the World Bank, the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) and 19 private foundations were reviewed.
The results showed that policies and technical guidelines related to GBV and HIV/AIDS are well represented; however, those relate to family planning and EmOC are severely lacking. To reduce maternal mortality and morbidity and improve the lives of women in emergency settings, governments, donors, UN agencies and international and local organizations must ensure that life-saving RH interventions are included in policies and technical guidelines related to emergency response and protracted crises, and that these interventions receive adequate funding.
While assessing a longer time period, the RAISE policy review complements a RAISE-initiated study tracking donor funding for RH in emergencies, described in an article by Patel et al (2009) that can be accessed at www.plosmedicine.org.
To view the full report on the policy review, visit www.raiseinitiative.org/library.
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2010 Annual Meeting Program Plans
Section Chair-Elect Henry Gabelnick,
CONRAD, Eastern Virginia Medical School,
1911 Fort Myer Drive,
Arlington, VA 22209 Phone: (703) 276-3904 E-mail: email@example.com
Denver, Nov. 6-10, 2010
The Population, Reproductive and Sexual Health Section will be offering a diverse program incorporating all of our Task Force and core topics. This year’s theme, “Social Justice: A Public Health Imperative” is particularly germane to many aspects of our work. You will find presentations from both a domestic and global perspective.
We have 24 panels linking with the conference theme:
• Abortion access: a social justice issue
• Acceptability and uptake of HPV vaccine
• Abortion and stigma
• Men’s access to reproductive health services
• Adolescent sex education
• Abortion: contextual factors
• Quality of care
• Barriers to abortion access
• Beyond family planning
• Contraceptive use
• Contextual factors in reproductive health
• Early sexual experiences: contexts and impact
• The choice of contraceptive method
• Teen pregnancy recidivism
• The roles of communication and education in sexual health
• Management and sustainability
• Sexual health and sexuality
• Reproductive and sexual health rights
• Sexual risk in adolescents
• Gender and sexual and reproductive health
• A closer look at the genitals to improve sexual health and wellbeing
• Promoting adolescent sexual health
• Global perspectives in adolescent sexual health
• Student career trajectories
We also are also planning to have the following poster sessions:
- Student poster session
- Adolescent Pregnancy Interventions
- Global Interventions on Adolescent Reproductive Health
- International Family Planning Interventions
- Male Involvement
- Domestic Perspectives on Adolescent Reproductive Health
- Contraceptive Choices
We would like to invite everyone to the Section Business and Task Force Meetings and to join us for our awards ceremony and reception. We welcome your ideas, suggestions and participation in future programming and Section activities.
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Leslie Kantor will be joining the Planned Parenthood Federation of America as the National Director of Education Initiatives on July 6. Leslie was previously at Columbia University's Mailman School of Public Health and is a widely recognized leader in the field of sexual and reproductive health with over two decades of contributions through academia, advocacy and program development.
Leslie has held pivotal roles in several organizations in the field of sexual and reproductive health including the Sexuality Information and Education Council of the United States (SIECUS) and Planned Parenthood of New York City, and has served on the boards of the National Campaign to Prevent Teen and Unplanned Pregnancy and Answer. Her contributions to the field have been recognized with two prestigious awards from the APHA – the Jay S. Drotman Memorial Award for “challenging public health practice in a creative and positive manner,” and the Early Career Award for Excellence from the Population, Reproductive and Sexual Health Section.
Leslie holds a BA magna cum laude from Barnard College, an MPH from the Mailman School of Public Health at Columbia University and is a PhD candidate at the Columbia University School of Social Work.
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Get involved in the Section:
Sign Up for Section Listserv
Our Section has set up a Google Groups listserv. This is a members only, private listserv. By joining the listserv you will be able to communicate with other Section members and become involved in our Section's program, research, policy and advocacy activities. Our goal is to use this listserv as the primary vehicle for communicating with Section members.
To join the listserv, please follow this link: http://groups.google.com/group/apha-prsh?hl=en
or send an e-mail to this address: firstname.lastname@example.org requesting to be added.
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Please visit our new website and learn more about the Population, Reproductive and Sexual Health Section.
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Submissions to the Newsletter
We are interested in sharing your news and/or your thoughts! Please feel free to to write a few kind words in memory of a colleague we've lost; inform Section members about books or papers you have recently published; or provide commentary on policy or program news that might be of interest. Please send all submissions by
Friday, Sept. 3, 2010 to:
Danielle B. Suchdev, MPH
Division of Reproductive Health
Centers for Disease Control and Prevention
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