Nat’l Women’s Law Center: Women Experiencing Declining Income, Increasing Poverty, and Loss of Private Coverage

Jodi Jacobson

Census data from 2008 show an increase in the number of women who have lost income, lost private coverage and are falling into poverty. The increase in the number of women without coverage stems from the continued erosion of private insurance –- primarily through the loss of job-based coverage--even before the worst of the economic crisis hit.

Census data released today for 2008 show that growing numbers of women lost private health care coverage, saw their incomes decline, and fell into poverty, according to an analysis by the National Women’s Law Center (NWLC).

The Census data released today are for 2008 and do not reflect the impact of the decline in real wages, dramatic increase in unemployment, and corresponding loss of employer-sponsored health insurance in 2009.

“The Census data show increasing numbers of women are joining the ranks of the uninsured – at great risk to their health and financial security,” said Marcia D. Greenberger, NWLC Co-President.

Compared to 2007, nearly half a million more women lacked coverage – bringing the total number of women without insurance in 2008 to nearly 17.6 million.
This increase in the number of women without coverage stems from the continued erosion of private insurance – primarily through the loss of job-based coverage. The increase would have been even higher if not for growth in public health care coverage such as Medicaid.

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“Women’s security and well-being – and that of their families – depends on Congress passing health reform legislation that will guarantee quality, affordable comprehensive health care for us all,” Greenberger said.

The data show that poverty and extreme poverty increased for women, children, and men. The number of women living in poverty increased by 800,000 since 2007 to a total of 15.2 million in 2008.

“Women’s poverty was already higher than men’s, so this increase should be a wake up call to policy makers to take swift action,” stated Nancy Duff Campbell, NWLC Co-President.

“The Economic Recovery Act is providing desperately needed help to many families and communities, but we need to do more to combat poverty, especially with growing unemployment rates,” Campbell said. “For example, it’s critical that Congress acts to extend unemployment benefits by the end of the year to over 1 million workers who will otherwise lose this critical help. The states, too, need to take advantage of the federal funds already available.”

NWLC’s analysis of the Census data finds:

The number of women, men and children with employer-sponsored health insurance (ESI) continued to decline. The overall number of people without health insurance rose to 46.3 million in 2008—a number that would have been even more pronounced if not for gains in public health insurance coverage.

  • The number of women without health insurance increased by nearly half a million in 2008. The uninsurance rate among women was statistically unchanged since 2007, with 15% of all women (more than one in seven) lacking coverage.

  • Rates of private health coverage continued to decline. For example, the percentage of women with private ESI declined from 58.5%  in 2007 to 57.8% in 2008 – representing a decrease of nearly a quarter of a million women.
    Gains in public health insurance offset the decline in private coverage rates among women. In particular, the proportion of women with Medicaid coverage rose from 9.8% in 2007 to 10.4% in 2008. Nearly 850,000 additional women had coverage through this essential program in 2008.

  • Rates of uninsurance among children continued to decline from 11% in 1007 to under 10% in 2008. This was primarily due to the continued success of public health insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP). In 2008, one in three children (33%) had public coverage, representing an increase of 1.7 million since 2007.

 

Poverty – and extreme poverty – increased significantly between 2007 and 2008 for women, children and men.

  • The number of women living in poverty rose to 15.2 million in 2008 from 14.4 million in 2007.  The number of children living in poverty rose to 14.1 million from 13.3 million and the number of men living in poverty rose to 10.6 million from 9.5 million.

  • Women’s poverty rate rose to 13% in 2008 from 12.5% in 2007.  The poverty rate among Hispanic women increased significantly – to 22.3% in 2008 from 20.8% in 2007 – while the poverty rate was statistically unchanged from 2007 among both White and Black women, at 9.4% and 23.3% respectively.

  • The child poverty rate rose to 19% in 2008 from 18% in 2007. The poverty rate for married-couple families with children rose significantly, to 7.5% in 2008 from 6.7% in 2007. 

  • The poverty rate for female-headed families with children was much higher than that for married couples, at 37.2% in 2008, but was statistically unchanged since 2007.

  • Men’s poverty rate increased to 9.6% in 2008 from 8.8% in 2007.
    The poverty rate for men increased at a faster rate than that of women or children between 2007 and 2008, but the poverty rate for women (13%) and children (19%) continues to be substantially higher than the poverty rate for men (9.6%).

  • The percentage of women and children living in extreme poverty – less than half of the federal poverty level – increased significantly.  The extreme poverty rate among women increased to 5.5% from 5.1%.  Among children, the extreme poverty rate increased to 8.5% from 7.8%. Among men, the extreme poverty rate increased to 4% from 3.5%.

Real median earnings declined for women and men in 2008 and the wage gap was 77%, statistically unchanged from 2007.

  • Median earnings for women working full time, year round, were $35,745 in 2008, down from $36,451 (adjusted for inflation) in 2007. 

  • Median earnings for full-time, year-round male workers were $46,367 in 2008, down from $46,846 (adjusted for inflation) in 2007.

  • Women working full time, year round in 2008 earned 77% of what comparable men earned – statistically unchanged from 2007.

  • Median earnings for White, non-Hispanic women working full-time, year round were $37,389 in 2008, 73% of the earnings of White, non-Hispanic men ($51,244). 

  • Median earnings for Black women working full-time, year round were $31,489, 61.4% of the earnings of White, non-Hispanic men. 

  • Median earnings of Hispanic women working full-time, year-round were $26,846, 52.4% of the earnings of White, non-Hispanic men.

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

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