What I didn’t get to say at the town hall meeting

Alison Cole

Many questions were asked about how to pay for health care reform.  I want to share some ideas with you. 

Emailed to WA Congressman Adam Smith after attending his Lakewood town hall this evening:

 

I attended your Lakewood town hall tonight, and appreciated your
intelligent answers and support for a public option in health care
reform.  Many questions were asked about how to pay for reform.  I want
to share some ideas with you. 

* INCREASED ACCESS TO MIDWIVES
AND OUT OF HOSPITAL BIRTH.  Medicaid pays for a lot of births, and
requiring federal Medicaid to reimburse a Certified Professional
Midwife in an out of hospital setting reduces costly intervention,
including Cesarean section.  The WHO recommends an optimal 15%
c-section rate and the US rate is now 31%.  These surgeries are costly,
many are unnecessary, and could be prevented with midwifery care for
healthy women.  Please watch this video:  www.reducinginfantmortality.com.

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INCREASED ACCESS TO ALTERNATIVE/COMPLEMENTARY PREVENTIVE CARE.  I
listened to a round-table on preventive care held by the
administration, and many medically-trained providers lamented the fact
that they did not get adequate training in disease prevention. 
Naturopaths, massage-therapists, acupuncturists, midwives, etc. all
provide low-tech preventive and wellness-promoting care.  This also
solves the problem of lack of adequate providers while expanding
patient choice.

* INCREASED ACCESS TO FAMILY PLANNING. 
Preventing unintended pregnancy reduces costs to insurers.  If everyone
had access to services provided by state family planning waiver
programs (like the Take Charge program in Washington), people would be
able to control their reproductive lives and save the state money.

*
REPEAL THE BUSH TAX CUTS AND INCREASE TAXES FOR THE WEALTHIEST
AMERICANS.  We all benefit from the great things the US has to offer,
and the ones who benefit the most need to give back the most. 

Thank you so much for the work you do for us.  Keep it up.

Sincerely,

Alison Duren-Sutherland
Medical Insurance Biller
Homebirth Mom
Apprentice Midwife

Commentary Abortion

Abortion Rates Alone Don’t Tell Us What We Need to Know About the State of Reproductive Wellness

Steph Herold

While a new Associated Press report suggests the abortion rate is declining in almost all states, we still don't know whether there's been an increase in reproductive wellness. Focusing only on a lowered abortion rate as metric of health and well-being is both inaccurate and stigmatizing of abortion.

Earlier this week the Associated Press released a report that found the abortion rate in the United States is declining by about 12 percent in almost all states. Across mainstream media reporting on this new statistic, abortion rights advocates argue this decline may be a combination of increased access to contraception and decreased access to abortion, while anti-choice advocates claim it’s a sign that their restrictive laws are having their intended impact and that the American people in general are rejecting abortion. Given these varying interpretations and the limitations of the data, it’s hard to know what a declining abortion rate really signifies.

So what’s really behind the declining abortion rate? And why do we care so much?

The documented decline in abortion rates seems to be linked to both worrisome trends and encouraging ones. Alarmingly, abortion is becoming significantly more difficult to access, especially for people in the South and Midwest and for people at or below the poverty level. The AP report states that at least 70 abortion clinics have closed since 2010, limiting access to reproductive health care for people across the country. We also know that insurers and employers are increasingly restricting coverage of abortion care. This means that more and more people have to choose between paying their rent and paying for an abortion. At the same time, the Affordable Care Act stipulates that insurers must completely cover contraception without co-pay, so more people than ever are able to access birth control options without the hurdle of affordability.

Taken together, these data present an incomplete picture. The “good news” may be that more people are having the pregnancies and births they want when they want: Unintended pregnancy rates are mostly falling The bad news? People are likely not able to access the abortions they need. Various factors can impact the abortion rate, and some of these factors suggest that the existing need for abortion is going unmet: new targeted regulation of abortion providers (TRAP) laws; new patient hurdles like increased waiting periods; meager emergency savings both overall and among women; and fewer insurance plans covering abortion. The frustrating truth is that we don’t yet have specific data that can help us know for sure which factors are most responsible for the current change in abortion rates.

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It is tempting to focus on lowered abortion rates alone as a metric of success, especially for legislators and anti-choice activists with a stake in this claim. Here’s the question we should be imploring ourselves and others to ask: Does a lower abortion rate truly signal an increase in reproductive wellness? Reproductive wellness might mean people being able to avoid unintended pregnancies; having access to good quality, shame-free preventive care, abortion, contraception, and prenatal care; and receiving the community and institutional support they need to achieve their reproductive hopes and dreams. We can’t really know if we’re achieving those goals without understanding what other events are happening in people’s reproductive lives.

Focusing on abortion rates alone can’t tell us what’s really important about the state of reproductive well-being, and also has the dangerous possibility of stigmatizing abortion. Highlighting this decreased abortion rate as a “success” suggests that abortion is happening more than it should, and that there are some conditions for which abortions should and should not occur. It also implies that there is something wrong with abortion, that the abortion rate should be low because abortion is inherently “different” from other parts of health care. As sociologist Tracy Weitz states, advocating for a lower abortion rate also sets up an unrealistic expectation that there’s a magic number of abortions that are acceptable, and once we reach that number, abortion will cease to be a divisive issue in U.S. culture. What we want is a decrease in the political and cultural conflict over abortion, not a decrease in abortions themselves.

Instead of focusing on the lowered abortion rate, let’s ask more complex research questions: What social and emotional factors contribute to people’s decision making related to an unintended pregnancy? How do people’s perceptions of their community’s social norms around pregnancy impact what they think they should do about an unintended pregnancy? A lower abortion rate in and of itself doesn’t tell us much without placing it in the social, cultural, and emotional context of people’s lives. Focusing only on a lowered abortion rate as metric of health and well-being is both inaccurate and stigmatizing of abortion.

Author’s note: Thanks to Roula AbiSamra for her help with this piece.

Commentary Abortion

Navigating the Military System to Get an Abortion: Olivia Pope Can’t Fix This Scandal

Renee Bracey Sherman

A recent Scandal episode highlighted a few barriers when attempting to seek an abortion while deployed, but what’s a service member to do when she doesn’t have Olivia Pope’s help navigating the system?

This piece is published in collaboration with Echoing Ida, a Forward Together project.

This season’s Scandal episodes have tackled some of today’s most pressing social issues, including the Black Lives Matter movement, gun control, and feminism. Recently, sexual assault and abortion have taken center stage. In the episode titled “A Few Good Women,” Vice President Susan Ross travels to the USS Montana for a photo op with enlistees and notices that a young woman, Ensign Amy Martin, has bruises on her wrists. Privately, the vice president questions Ensign Martin about her injuries and it is revealed that a high-ranking admiral, and friend of the president, raped her. When the president tells Vice President Ross not to intervene in the military jurisdiction, she turns to everyone’s favorite fixer, Olivia Pope, to ensure Ensign Martin receives justice.

While Olivia Pope and her team fight to prove that the rape occurred, Ensign Martin realizes that she became pregnant and wants to seek an abortion immediately. “I have to get off the ship. I need you to get me an abortion,” Ensign Martin says to Pope. Their conversation is cut short by an officer who charges Ensign Martin with “conduct unbecoming,” which restricts her ability to leave the ship. With the creativity of her team, Olivia Pope cites an ill relative to free Ensign Martin from the ship so that she can seek abortion care. The most powerful image in the episode is when Pope stands tall holding Ensign Martin’s hand during Martin’s abortion.

The episode highlights a few barriers when attempting to seek an abortion, but what’s a service member to do when she doesn’t have Olivia Pope’s help navigating the system?

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Currently, about 14 percent of the U.S. military on active duty are women and 97 percent are of reproductive age. (It is estimated that about 15,000 military personnel identify as transgender or gender nonconforming, but due to regulations and lack of inclusion under “Don’t Ask, Don’t Tell,” they are still unable to serve openly. Therefore research statistics do not include trans or gender nonconforming service members seeking abortion care for any number of reasons.) Due to the persistent rape culture within the military ranks, an estimated 20 to 43 percent of women experience “rape or attempted rape” during their military careers. Even more startling, the Department of Defense believes that over 85 percent of rapes are not reported due to fear of retaliation. According to the Department of Defense, over 60 percent of survivors who reported their rapes experienced some form of retaliation—exactly the storyline of that recent Scandal episode.

Whether or not a service member reports their rape, they may face a myriad of psychological and physical health effects, including unintended pregnancy. Acknowledging the serious sexual assault risks to service members, Congress passed the Shaheen Amendment in 2013 allowing TRICARE funds to be used for abortion care, though only in the cases of rape, incest, and health. Prior to the amendment, service members and their dependents could only use their TRICARE health insurance for abortions in the case of life endangerment. This bipartisan bill sought to bring the military policy in line with the overall federal policy governed by the discriminatory Hyde Amendment, which bans federal funds from being used for abortion unless under specific circumstances such as rape. While the Shaheen Amendment is a win for service members who have been raped and want an abortion, it doesn’t clear access for people in the military who become pregnant from having consensual sex and seek an abortion—a majority of whom do not want to have children at that moment and desire to finish their military career. Why are we as a nation asking service members to honor their country through military duty, yet systematically denying them abortion access and the very rights for which they are fighting?

As research shows, pregnancy while serving in the military is common, particularly among less privileged service members. In a recent study, Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health, found that servicewomen experience unintended pregnancy at higher rates than the national average—54 percent as compared to 49 percent. Mirroring national statistics, women of color, personnel who are enlisted at a lower pay grade, younger members, and those without a college degree tend to experience higher rates of unintended pregnancies. A majority of respondents cited lack of access to contraception and sexual health education as a barrier to preventing pregnancy. They also cited challenges in obtaining refills for birth control or in visiting a provider while deployed. Additionally, many said they were confused by the laws as to whether or not they could seek birth control.

Similarly, in a 2011 study, Dr. Grossman looked at the experiences of service members seeking abortion while serving abroad. Similar to the civilian population, 56 percent already had one or more children and 78 percent said it was not a good time for them to have a child. About half said their unintended pregnancy was a failure of their contraceptive method, and many cited lack of access to contraception, emergency contraception, and gynecological care as major barriers. For its part, the House of Representatives passed a new policy stating that military clinics and hospitals must dispense all FDA-approved forms of contraception and give service members a “sufficient supply” of their birth control method as part of the annual defense policy bill last Friday.

“Deployed women face additional barriers, since they may be on a ship at sea or in countries where abortion is legally restricted and/or where security issues make travel off-base to obtain care very difficult,” Dr. Grossman told Rewire.

“Other barriers are related to lack of geographic proximity to providers, since many bases are located in more remote areas, and active-duty service members can only travel so far depending on how long their leave is for,” Dr. Grossman explained. If a service member becomes pregnant and wants an abortion, they must notify their chain of command to request leave and, if the pregnancy was not the result of rape or a danger to their health, cover the entire cost of the abortion and the evacuation from their deployment, which can amount to more than $10,000 per person. “It would take too much time for me to be sent back to the States and processed for me to meet the 9-week requirement for [a medication abortion],” explained one woman stationed in Iraq. If a pregnant person is deployed in an active war zone, it can take weeks to coordinate the evacuation, which increases the cost of the abortion and limits their clinic options, since not all providers offer later abortion care.

Even for those who do have the financial means to pay for their abortion out of pocket, the country in which they are stationed may prohibit abortion except in cases of life endangerment. It is very common for the Department of Defense to follow the laws of a host country, forcing service members to travel for legal abortion care, seek illegal care, or self-induce. In Dr. Grossman’s 2011 study, 68 percent of the women seeking abortions were deployed in countries where the health procedure is banned.

Further, notifying the chain of command infringes on their privacy around their decision, can get them in trouble for having sexual relationships while serving, and can put them in additional danger for retaliation if the pregnancy was a result of rape. Dr. Grossman said there’s a “lack of confidentiality if they say they’re pregnant and ask for leave for an abortion.”

For others, abortion stigma and fear of losing their job force them to seek an abortion outside of the military. “If the Army finds out that I am pregnant they will kick me out of the Army. The salary I earn supports my mother and two sisters at home. I cannot afford [for] this to happen. Please, please help me,” wrote one woman stationed in Iraq, whose consultation data was included in Grossman’s study.

Abortion stigma also results in limited access to abortion care in military treatment facilities. Due to lack of training in abortion care in military medical schools, few abortion providers, and refusal to provide abortions by military medical staff, access is low. According to the Department of Defense, an average of 3.79 abortions were performed on military facilities each year for the past 15 years. A woman stationed in Iraq said, “the Army makes it impossible to keep my pregnancy confidential and not everyone is open-minded about abortions.”

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