Actions Taken On Women's Health-Related Legislation, Programs In Arizona, Maryland, Wisconsin

The following highlights recent news of state and local actions on women's health-related issues.

Emergency Contraception
Wisconsin: Senate Majority Leader Judy Robson (D) on Tuesday said she plans to reintroduce legislation that would require hospitals to inform rape victims that emergency contraception is highly effective at preventing pregnancy and dispense EC if survivors requested it, the AP/LaCrosse Tribune reports. According to the legislation, hospitals that refused to follow the mandate would face sanctions from the state. Democrats have failed to gather enough support to pass similar legislation introduced in at least the last three legislative sessions, the AP/Tribune reports. Assembly Speaker Mike Huebsch (R) said he has not taken a stance on the bill and could not predict its chances for passage in the House. EC can prevent pregnancy if taken within 72 hours after intercourse (AP/LaCrosse Tribune, 3/6).

Prenatal Care
Arizona: The Senate Appropriations Committee last week unanimously approved a bill (SB 1361) that would require the Arizona Health Care Cost Containment System to provide no-cost prenatal care to women whose household incomes are below 185% of the federal poverty level, the Capitol Media Services/Arizona Daily Star reports. State law now requires the system to cover prenatal care cost to women whose household incomes are below 133% of the poverty level. The legislation would make about 2,700 more women eligible for no-cost care annually. According to legislative aides, the program would cost about $4.4 million if 20% of eligible women enroll and would cost about $17.7 million if 80% of eligible women enroll. Sen. Barbara Leff (R), who is co-sponsoring the legislation, said the bill eventually would save the state money because providing prenatal care to more women would reduce costs related to preterm births and childbirth-related complications. The legislation now moves to the full Senate for consideration (Fischer, Capitol Media Services/Arizona Daily Star, 2/28).

Sex Education
Maryland: Montgomery County, Md., Public Schools on Tuesday began a pilot program at a middle school in the district for a new sex education curriculum that teaches eighth- and 10th-grade students about sexual and gender identity issues and that includes a condom demonstration video, the Washington Post reports (de Vise, Washington Post, 3/7). The Montgomery County Board of Education in January voted 8-0 to approve the curriculum for the program, which includes two 45-minute classes for eighth-grade students and three 45-minute classes for 10th-grade students. Only students whose parents have provided written consent can participate in the lessons (Kaiser Daily Women's Health Policy Report, 1/11). The program, which began on Tuesday at Argyle Middle School in Silver Spring, Md., is scheduled to begin at five schools by the end of the month and throughout the district by the fall (Washington Post, 3/7). The groups Citizens for a Responsible Curriculum, Family Leader Network and Parents and Friends of Ex-Gays and Gays on Feb. 7 filed a petition against implementation of the curriculum with the Maryland State Board of Education (de Vise [1], Washington Post, 3/8). The groups also sought to halt the pilot program, but Maryland Superintendent Nancy Grasmick on Wednesday denied the request (Marech, Baltimore Sun, 3/8). Grasmick in the five-page order also told the education board to rule by July on whether the curriculum should be implemented district-wide. The groups claim that the "content of the lessons is inherently harmful because it violates their First Amendment rights," Grasmick wrote, adding, "I have read the lessons, and I am not convinced of the certainty of such violations. I am convinced, however, of the value of going forward with the field test" (de Vise [2], Washington Post, 3/8).














"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

American Academy Of Dermatology Says FDA Not Likely To Postpone Start Date For Accutane Registry

The American Academy of Dermatology on Tuesday said that, despite its concerns about a program that seeks to reduce the number of pregnant women who use the acne medication isotretinoin, sold under the brand name Accutane, FDA has said the program will begin as planned, the AP/San Jose Mercury News reports (Schmid, AP/San Jose Mercury News, 2/21). FDA on Dec. 30, 2005, began to register physicians, prescription drug wholesalers, pharmacists and women into the program, known as iPledge, after an FDA advisory committee in March 2004 recommended the program. Under the program, women must submit two negative pregnancy tests before they can receive an initial prescription for isotretinoin and must undergo a monthly pregnancy test before each refill. In addition, women must agree to use two forms of birth control at the same time or to abstain from intercourse for one month prior to treatment with isotretinoin, during treatment and for one month after treatment has ended, according to FDA. Women also must sign a document to acknowledge that isotretinoin can increase risk for birth defects, depression and suicidal thoughts. The program also requires physicians who prescribe isotretinoin and wholesalers and pharmacists who distribute the medication to register with the database. About 88% of the nation's 55,000 pharmacies and 56% of the estimated 36,000 doctors who prescribe Accutane have registered with system, and 17,881 patients had registered with the program as of the week of Feb. 13. FDA officials earlier this month said they were considering postponing the mandatory start date of March 1 after glitches in the program delayed registration (Kaiser Daily Women's Health Policy Report, 2/13). AAD President Clay Cockerell said in a statement that with the decision not to delay the iPledge start date, "it is now the duty of the FDA to guarantee that the flaws, inconsistencies and confusion" in the program are fixed. According to the AP/San Jose Mercury News, FDA has not confirmed that it will not postpone the start date (AP/San Jose Mercury News, 2/21).


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . ?© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

New England Journal Of Medicine Publishes Perspective Pieces Responding To Supreme Court Ruling Federal Abortion Ban Constitutional

The New England Journal of Medicine on Thursday published three perspective pieces responding to the Supreme Court's 5-4 ruling on Wednesday to reinstate a federal law banning so-called "partial-birth" abortion, overturning the rulings of three appeals courts. Chief Justice John Roberts and Justices Samuel Alito, Clarence Thomas and Antonin Scalia joined Justice Anthony Kennedy in the majority opinion and Justices Stephen Breyer, John Paul Stevens and David Souter joined Justice Ruth Bader Ginsburg in the dissent. President Bush signed the Partial-Birth Abortion Ban Act (S 3) into law in November 2003. The Planned Parenthood Federation of America, the American Civil Liberties Union on behalf of the National Abortion Federation, and the Center for Reproductive Rights on behalf of four abortion providers filed lawsuits alleging that the law is unconstitutional because of the absence of an exception for procedures preformed to protect the health of the pregnant woman. In place of a health exception, the law includes a long "findings" section with medical evidence presented during congressional hearings that, according to supporters of the law, indicates the procedures banned by the law are never medically necessary. The law says a physician who performs the banned procedures could face criminal prosecution, fines and up to two years in jail. The law allows an exception for cases in which the life of the woman is in danger, but it does not permit doctors to use the procedure because they believe using another method would increase risks to the woman's health (Kaiser Daily Women's Health Policy Report, 4/19). Summaries appear below.

R. Alta Charo: The ruling marks "a significant change in abortion jurisprudence," with "women's health no longer paramount but rather societal morality and the state's interest in life even before the point of viability outside the womb," Charo -- a professor of law and bioethics at the University of Wisconsin-Madison and member of the Guttmacher Institute board -- writes in a NEJM perspective. According to Charo, the ruling "illustrates how fragile are the constitutional interpretations by which reproductive rights are guaranteed" (Charo, New England Journal of Medicine, 4/23).

Jeffrey Drazen: With "this decision, the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine," Drazen, a pulmonary and intensive care physician, writes in a NEJM editorial. "It is not that physicians do not want oversight and open discussion of delicate matters but, rather, that we want these discussions to occur among informed and knowledgeable people who are acting in the best interests of a specific patient," Drazen writes, adding, "Government regulation has no place in this process" (Drazen, New England Journal of Medicine, 4/23).














Michael Greene: The ruling has "cast a pall over those who practice reproductive medicine" by creating an "intimidating environment surrounding pregnancy terminations at more advanced gestational ages," Greene -- an associate NEJM editor and professor of obstetrics, gynecology and reproductive biology at Harvard Medical School -- writes in a NEJM perspective. Greene adds, "Both health care providers and patients should be alarmed by the current degree of intrusion by our government into the practice of medicine and even more so by the apparent trajectory that it seems poised to follow in the near future" (Greene, New England Journal of Medicine, 4/23).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Multiple Birth Mothers Aren't Restricted To Cesarean Surgeries

When it comes to twin births, two times the fun doesn't always mean twice as many complications. Cesarean surgeries are not requirements for women pregnant with multiple babies. Not only is it possible for mothers of multiples to give birth vaginally, but research shows that it often is the safer option.


From the beginning of their pregnancy, women carrying multiple babies may be labeled high-risk and inundated with precautionary information. The assumption, which often is supported by hospitals, is that unplanned cesarean surgery in labor is likely and therefore planned cesarean surgery is the safer option. Lamaze International, an advocate for normal birth and a leader in childbirth education, warns women not to make this assumption and points to research showing the dangers of unnecessary cesarean surgery.


A study published in the Cochrane Library, an international repository research on the effects of health care practices, reports that there is not enough evidence to suggest that elective cesarean surgery with twins results in better outcomes. A second study on multiple births reveals that cesarean surgery for delivery of the second twin (when the baby is not in the head-down position) increases the risk of infection and produces no obvious benefit for mother or baby.


At a rate of 29.1 percent in 2004, birth by cesarean surgery is on a drastic rise. The increase is attributed to several factors, including fear of malpractice claims, the incorrect perception that cesarean surgeries are safer and will prevent future urinary and uterine problems, hospitals' policies against vaginal birth after cesarean (VBAC) and the increase in multiple births. The Public Citizen Health Research Group in Washington, D.C., estimates that half of the nearly one million cesareans performed every year are medically unnecessary.


In today's "culture of cesareans," mothers of multiples face an uphill battle for choices in childbirth. While women carrying multiple babies are more likely to encounter complications than mothers of single babies, cesarean surgery is not mandatory and increases risks. Research indicates that women who undergo cesarean surgery increase the risk of infection, hemorrhage, surgical and anesthetic complications, and maternal death, as well as newborn respiratory problems. Future reproductive problems associated with previous cesarean surgery include infertility, uterine rupture, preterm birth, low birth weight, and stillbirth. According to the American College of Obstetricians and Gynecologists, a vaginal birth is possible for mothers of twins when the first twin is positioned head-down, which is nearly 80 percent of the time. Additionally, a mother of triplets is a candidate for a vaginal birth if she has an uncomplicated pregnancy, has not has previous uterine surgery and is at least 32 weeks pregnant at the time of birth.


"I would advise any woman expecting twins to find a caregiver who does not routinely perform cesareans for twin births," Judith A. Lothian, RN, PhD, LCCE, FACCE, author of The Official Lamaze Guide: Giving Birth with Confidence. Choosing a caregiver skilled in multiple births is important for mothers who want to increase their chances of having a vaginal birth. The Official Lamaze Guide is a guide for expectant mothers, and covers pregnancy, birth and early parenthood.


Lamaze International, based in Washington, DC, envisions a world of confident women choosing normal birth.

For more information about Lamaze and the Institute for Normal Birth, visit lamaze.

Pulmonary Hypertension Discrimination: Mortality Highest Among African American Women

African-American women have the highest mortality rate for idiopathic pulmonary arterial hypertension (IPAH), according to new research. The study, presented at CHEST 2006, the 72nd annual international scientific assembly of the American College of Chest Physicians (ACCP), revealed that racial disparities exist in pulmonary hypertension mortality and morbidity, with African-American women exhibiting the highest mortality rate when compared with all other groups.



"Idiopathic pulmonary arterial hypertension, by definition, means that there is no clear attributable cause for this disease," said study author Kala Davis, MD, Stanford University School of Medicine, Stanford, CA. "What has become apparent from this and other studies is that we have been operating with a very limited understanding of the epidemiology of IPAH, and that understanding is now changing."



Dr. Davis and colleagues reviewed data from the United States National Center for Health Statistics from the years 1994 to 1998 for deaths, in which the underlying cause was IPAH. The age, gender, race, and state of residence of the deceased were abstracted, and state-age-gender-race-specific tabulations of deaths, as a result of IPAH, were aggregated into nine geographic regions of the United States, as defined by the Census Bureau. Average, annual, age-adjusted, region-race-gender-specific rates were then calculated.



According to the United States National Center for Health Statistics, a total of 10,053 IPAH-related deaths were reported from 1994 to 1998. Researchers found that, although more Caucasian women reported having the disease, African-American women had the highest mortality rate among all IPAH-related deaths. In addition, researchers found that the highest mortality rates in IPAH were also observed at the extremes of the age spectrum.



"Women overall have higher mortality rates for IPAH, but the substantial difference shown in mortality rates between African-American women and Caucasian women, of all ages, was surprising," said Dr. Davis. "Further analysis of IPAH mortality data from 1999 to 2002 confirms that this trend is continuing." While the reasons for this disparity remain unclear, researchers suggest that under-recognized comorbidities, access to care, insurance, and race-specific genetic factors, are now being recognized as potential causes.



"Race, gender, and age have become defining factors in assessing the risk of death in IPAH," Dr. Davis concluded. "Clinicians must therefore be cognizant of this emerging demographic profile, which contrasts with the classic description of the condition as being a disease of middle aged, Caucasian women."



Pulmonary arterial hypertension is a rare disorder that affects the blood vessels within the lungs and leads to an increase in the pressure within the pulmonary arteries. This can lead to symptoms, such as unexplained shortness of breath on exertion, chest pain, fainting, and death. In the United States, an estimated 500 to 1,000 new cases of idiopathic pulmonary hypertension are diagnosed each year.



"Idiopathic pulmonary hypertension is a serious illness that is difficult to diagnose and manage," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "The results of this study provide a new outlook in terms of race and gender as risk factors for increased mortality in IPAH and may provide further insight into the management of IPAH in specific populations."







CHEST 2006 was the 72nd annual international scientific assembly of the American College of Chest Physicians, held October 21-26 in Salt Lake City, UT. ACCP represents 16,500 members who provide clinical respiratory, critical care, sleep, and cardiothoracic patient care in the United States and throughout the world. The ACCP??™s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.



Contact: Jennifer Stawarz


American College of Chest Physicians