Videos Examine Debate Over Abortion Debate in Health Reform, International Women's Day

March 11, 2010 — The following summarizes selected women's health-related videos.

Uncertainty Surrounds 'Stupak Dozen': On Wednesday, MSNBC host Rachel Maddow challenged Rep. Bart Stupak's (D-Mich.) claim that he has about twelve lawmakers who will vote against the Senate health reform bill if it doesn't include more restrictions on abortion coverage. According to a senior House leadership aide, an informal whip count found that only four or five House members are willing to back Stupak, Maddow reported (Maddow, "The Rachel Maddow Show," MSNBC, 3/10).

Sebelius Discusses Abortion Language in Health Reform: HHS Secretary Kathleen Sebelius took the Obama administration's health reform message to ABC's "This Week" and NBC's "Meet the Press" on Sunday. In discussing abortion coverage, Sebelius said, "Neither the Senate or the House bill has any federal funding for abortions, none" (Dowd, "This Week," ABC, 3/7). She also said, "There are very clear rules that apply across the board on federal funding for abortion coverage, and that's what we'll have at the end of the day" (Gregory, "Meet the Press," NBC, 3/7).

DeGette Explains Reform Abortion Debate: Rep. Diana DeGette (D-Colo.) -- co-chair of the Congressional Pro-Choice Caucus -- spoke with "Rachel Maddow" guest host Chris Hayes about the caucus' efforts to ensure that health reform legislation does not go beyond the current ban on the use of federal money for abortion. "History shows that if we pass a restriction on a woman's right to choose, we'll never get that back," she said (Hayes, "The Rachel Maddow Show," MSNBC, 3/9).

 White House Marks International Women's Day: During a speech at a reception to celebrate International Women's Day, first lady Michelle Obama noted that the administration lifted the "global gag rule," which she said "restricted women's access to family planning services abroad." The first lady also discussed the administration's efforts to invest in child and maternal health, and the creation of the Office of Global Women's Issues at the State Department (White House release, 3/8).

Videos Examine Debate Over Abortion Debate in Health Reform, International Women's Day

March 11, 2010 — The following summarizes selected women's health-related videos.

Uncertainty Surrounds 'Stupak Dozen': On Wednesday, MSNBC host Rachel Maddow challenged Rep. Bart Stupak's (D-Mich.) claim that he has about twelve lawmakers who will vote against the Senate health reform bill if it doesn't include more restrictions on abortion coverage. According to a senior House leadership aide, an informal whip count found that only four or five House members are willing to back Stupak, Maddow reported (Maddow, "The Rachel Maddow Show," MSNBC, 3/10).

Sebelius Discusses Abortion Language in Health Reform: HHS Secretary Kathleen Sebelius took the Obama administration's health reform message to ABC's "This Week" and NBC's "Meet the Press" on Sunday. In discussing abortion coverage, Sebelius said, "Neither the Senate or the House bill has any federal funding for abortions, none" (Dowd, "This Week," ABC, 3/7). She also said, "There are very clear rules that apply across the board on federal funding for abortion coverage, and that's what we'll have at the end of the day" (Gregory, "Meet the Press," NBC, 3/7).

DeGette Explains Reform Abortion Debate: Rep. Diana DeGette (D-Colo.) -- co-chair of the Congressional Pro-Choice Caucus -- spoke with "Rachel Maddow" guest host Chris Hayes about the caucus' efforts to ensure that health reform legislation does not go beyond the current ban on the use of federal money for abortion. "History shows that if we pass a restriction on a woman's right to choose, we'll never get that back," she said (Hayes, "The Rachel Maddow Show," MSNBC, 3/9).

 White House Marks International Women's Day: During a speech at a reception to celebrate International Women's Day, first lady Michelle Obama noted that the administration lifted the "global gag rule," which she said "restricted women's access to family planning services abroad." The first lady also discussed the administration's efforts to invest in child and maternal health, and the creation of the Office of Global Women's Issues at the State Department (White House release, 3/8).

Weekly Video Round Up!

Our weekly video roundup includes a unique assortment of Web videos hand picked by our editors. This week we're featuring: Uncertainty Surrounds 'Stupak Dozen' | Sebelius Discusses Abortion Language in Health Reform | DeGette Explains Reform Abortion Debate | White House Marks International Women's Day.

Washington Post Opinion Piece Draws Attention to Breast Ironing in Cameroon

March 8, 2010 — In a Washington Post opinion piece on Sunday, freelance writer Jamie Rich examined the Cameroonian practice of breast ironing, in which women use heated plantain leaves or hot stones to "flatten adolescent girls' developing breasts, intending to protect the girls from the dangers of sex, consensual or otherwise." The issue gained some international attention in 2006, when a not-for-profit launched an awareness campaign and the State Department began including breast ironing in its annual international human rights report. "But despite the increased attention, the practice persists," Rich says.

Local health advocates estimate that breast ironing affects as many as one in four girls, according to Rich, who interviewed Cameroonian women, girls, doctors and community organizers about the practice while living in the country. She writes, "Despite the pain and fear, many of the women and girls involved in breast ironing considered it a normal treatment for early breast development." Women believe that masking the development of their daughters' breasts will stave off attention from boys and men, Rich says. She adds, "Mothers told me they forcibly try to eliminate signs of puberty to protect their preteen girls from HIV and pregnancy. One mother explained that she did it out of love."

Rich continues, "In Cameroon, being young and pregnant is not uncommon." Local health workers estimates that about 30% of women experience unwanted pregnancies, she writes. Serges Moykam -- an ob-gyn in Douala, Cameroon -- said that promiscuity and rape both contribute to the high teen pregnancy rate and that breast ironing has no effect on either. He estimated that pregnant girls ages 12 to 17 make up 25% to 30% of his patients, adding, "It's very rare to see a 13-year-old girl who is still a virgin."

According to Flavien Ndonko -- an anthropologist at the German Agency for Technical Cooperation who runs the organization that launched the 2006 campaign -- breast ironing can lead to abscesses, infection, deformation, lactation problems, cysts, emotional stress and possibly breast cancer.

Rich writes that various groups take different approaches to combating breast ironing. Justine Kwachu, executive director of Women in Alternative Action, lobbies for criminalizing breast ironing, with 10-year prison sentences for individuals convicted of the practice. However, Vice Speaker of the National Assembly Emilia Lifaka said that few women still practice the custom and that education, not legislation, should be the approach to curbing breast ironing (Rich, Washington Post, 3/7).

Washington, D.C., To Become First U.S. City To Distribute Free Female Condoms

March 8, 2010 — Washington, D.C., soon will become the first city in the U.S. to distribute female condoms at no charge, the Washington Post reports. Around 500,000 female condoms will be available within the next three weeks in beauty salons, convenience stores and high schools in parts of the city where a study found that large numbers of black heterosexuals engage in risky sexual behavior that raises their chances of contracting HIV.

Shannon Hader, director of the D.C. HIV/AIDS Administration, said, "Anywhere male condoms are available, female condoms will be available." She added, "We're trying to make every effort count to build on what already exists [and] to expand options rather than limit them."

According to the Post, the project is an official acknowledgement of the difficulties of relying solely on male condoms -- which have been available at no cost in D.C. for almost 10 years -- in combating the spread of HIV. City officials said they are providing female condoms to increase women's ability to protect themselves from HIV and other sexually transmitted infections if their partners refuse to wear condoms.

A $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics, is funding the project. MAC Cosmetics has contributed to several city initiatives, including two of D.C.'s needle exchange programs. The grant aided the city in purchasing the condoms from Female Health and giving them to social service organizations, including Planned Parenthood, the Community Education Group and the Women's Collective (Fears, Washington Post, 3/6).

Home-Administered Misoprostol Safe Abortion Option for Women Up to 63 Days Pregnant, Study Finds

March 11, 2010 — A team of Swedish researchers concludes that taking misoprostol at home as part of a medical abortion regimen is a safe option for women who are 50 to 63 days pregnant, according to a study published in the journal Human Reproduction, Reuters reports. The study's authors said that their research is the first published report to examine at-home medical abortion in women who were more than 49 days pregnant.

In the U.S., women have been permitted to take physician-prescribed misoprostol at home since 2000. Mifepristone -- the first drug in the medical abortion regimen, which is taken three to four days prior to misoprostol -- is administered at a clinic, physician’s office or hospital. Most European countries require that women take both drugs in a clinic, doctor's office or hospital, although home administration is permitted in Sweden, Reuters reports.

For the study, Helena Kopp Kallner of the Karolinska Institutet in Stockholm and colleagues followed about 3,000 medical abortion patients at their clinic in Sweden from January 2004 through April 2007. Of the women, 395 opted for home administration of misoprostol. Of those 395 women, 203 were fewer than 50 days pregnant and 192 were 50 to 63 days pregnant. The home-administration group took mifepristone orally at the clinic and was given four misoprostol tablets to administer vaginally up to two days later.

Among women who were fewer than 50 days pregnant, 199 experienced complete abortions, while 186 of the women who were between 50 and 63 days pregnant experienced complete abortions. Ten women required surgery. About six in 10 women in both groups needed extra pain medication. The study concluded that home administration of misoprostol is "safe and highly acceptable also to women with a gestational length of 50-63 days as compared with shorter gestations" (Reuters, 3/9).

Politico Opinion Pieces Argue for U.S. Investment in Global Women's Issues

March 8, 2010 — On International Women's Day, Politico published two opinion pieces discussing the benefits of U.S. aid to support women overseas.

~ Dana Perino, Politico: "Empowering one woman is an investment in the future of families and countries," Perino -- a former press secretary to President George W. Bush -- writes in an opinion piece discussing her work with Women ONE2ONE in Africa. She notes that "[o]ne in every 22 African mothers die in childbirth, more than 200 times the rate in the United States." Perino continues, "I believe that, as an American woman, I can help bring opportunity to women in the developing world by spreading their stories and urging our country's lawmaker to make smart investments." She adds, "From what I have seen, our aid money is being well spent," as African women often "stretch every dollar, spending in innovative ways." Perino writes, "Together, we can pool our power to connect, take action and help shape a better, more profitable future for the women I met, their families and, ultimately, their countries" (Perino, Politico, 3/8).

~ Ann Lewis/Susan Molinari, Politico: "Encouraging education, economic opportunity and good governance helps to build a more secure and safer world," according Lewis -- former director of communications for President Clinton and adviser to the U.S. Global Leadership Coalition -- and Molinari -- a former Republican House member from New York and adviser to USGLC. "Investment in women and girls' education and empowerment is increasingly recognized as a linchpin to advancing social, economic and political progress in most poor countries," Lewis and Molinari write. They add, "Girls with just one year of formal education are less likely to suffer from illness or hunger and more likely to avoid teen pregnancy, and their children are less likely to die in infancy." U.S. aid for "human and economic development now -- on education, basic health and infrastructure -- is a smart investment," which is why "Democrats and Republicans agree that more resources are needed for these programs, including funds for agricultural development, health and women and girls," the authors write (Lewis/Molinari, Politico, 3/8).

Sex Education, Contraception Key to Lowering Abortion Rate Among Blacks, Guttmacher CEO Writes

March 8, 2010 — In a New York Times letter to the editor published on Monday, Guttmacher Institute President and Chief Executive Sharon Camp calls for the U.S. to "get serious about providing better health care and more educational and economic opportunities for black women." Responding to a recent Times article on antiabortion-rights groups' campaigns to target black women, Camps writes that "abortion within the African-American community should be discussed in its proper context."

Camp notes that "[d]isproportionately high abortion rates among black women are a direct result of their higher rates of unintended pregnancy, which in turn reflect economic and social inequalities that are widespread and pervasive." Antiabortion-rights advocates "ignore" systemic inequities on various reproductive health outcomes and health indicators, including diabetes, heart disease, HIV/AIDS and cancer, according to Camp. They "falsely and cynically ... accuse abortion providers of targeting minority communities," she continues.

"Rather than promoting bogus conspiracy theories, let's focus on making comprehensive sex education and affordable contraceptive services universally available to reduce rates of unintended pregnancy and abortion," Camp concludes (Camp, New York Times, 3/8).

Research Shows Removing Healthy Breast Does Not Improve Breast Cancer Survival, NYT Columnist Writes

March 10, 2010 — Recent studies show that more women with cancer in one breast are opting for removal of both breasts, even though removal of the healthy breast does little to improve survival rates, New York Times columnist Tara Parker-Pope writes. In 2006, roughly 6% of women who underwent surgery for breast cancer chose to remove both the cancerous and healthy breasts, a procedure known as contralateral prophylactic mastectomy, Pope says. According to a University of Minnesota study presented last week at the annual meeting of the Society of Surgical Oncology, 10% of women in their 40s who underwent breast cancer surgery chose to have both breasts removed. A 2009 study in the Journal of Clinical Oncology found that among women who had surgery for ductal carcinoma in situ -- one of "the earliest, most curable forms of cancer" -- the rate of double mastectomy increased from 2.1% in 1998 to 5.2% in 2005, Parker-Pope writes.

According to Parker-Pope, although removing two healthy breasts can reduce the risk of breast cancer in women with a genetic predisposition to the disease, "for most women given a diagnosis of breast cancer, cutting off a healthy breast does not improve the odds of survival." For example, a new study in the Journal of the National Cancer Institute examining data on 108,000 women who underwent mastectomy -- including 9,000 women who opted to remove both a healthy and a cancerous breast -- found that a survival benefit only occurred in a small group of women who were younger than age 50 and diagnosed with early-stage estrogen-receptor-negative tumors that were unresponsive to treatment with risk-lowering drugs. Isabelle Bedrosian, a surgical oncologist at M.D. Anderson Cancer Center and a study researcher, said, "Part of the reason women are frightened is we haven't given them good information," adding, "Part of my hope with this study is to tell most breast cancer patients that it's O.K. not to do this."

Parker-Pope writes that many "women who have opted for the procedure say it's not about the statistics" but about a desire to never relive the stress of undergoing a mammogram or breast biopsy. Some patients also say they have chosen to remove both breasts so their breasts are symmetrical after their operations, she adds (Parker-Pope, "Well," New York Times, 3/8).

Senate Judiciary Committee Approves Office of Legal Counsel Nominee Johnsen for Second Time

March 8, 2010 — The Senate Judiciary Committee on Thursday voted 12-7 along party lines to approve the nomination of Dawn Johnsen to be assistant attorney general for the Justice Department's Office of Legal Counsel, CQ Today reports. The committee had already approved Johnsen nearly one year ago, but her nomination was never brought to the full Senate. President Obama re-nominated Johnsen in January after the first nomination expired at the end of 2009.

Republicans on the Judiciary Committee have criticized Johnsen over her positions on national security issues and her past work with NARAL Pro-Choice America. They claim she is "too partisan" for the position, according to CQ Today.

Committee Chair Patrick Leahy (D-Vt.) took issue with GOP criticism of Johnsen, whom he said would "thoughtfully analyze -- not simply rubber stamp -- the legality of administration policies" (Anderson, CQ Today, 3/4).

Blogs Comment on Abortion Coverage in Health Reform, International Women's Day, Other Topics

March 9, 2010 — The following summarizes selected women's health-related blog entries.

~ "Stupak's Abortion Argument: Still More About Class Than Choice": Washington Post's "Ezra Klein": The "practical effect" of Rep. Bart Stupak's (D-Mich.) position on abortion-related language in health reform legislation "is not that the federal government will not subsidize abortion by subsidizing health care insurance" but that "it will not subsidize abortion by subsidizing health care insurance for poor women," Klein writes. Klein includes an excerpt from Post colleague Matt Miller's recent blog post on the subject. Miller wrote, "This entire debate is ridiculous, because the feds already subsidize abortions massively, via the giant tax subsidy for employer-provided care. Today the feds devote at least $250 billion a year to subsidizing employer-based coverage, a subsidy that skews incentives horribly (but which big business and big labor wouldn't let the politicians touch this year)." Miller also noted that data from the Guttmacher Institute show that 87% of typical employer plans cover abortion services. According to Klein, Stupak's amendment -- which would bar all insurance plans that receive federal subsidies from covering abortion -- "is as much about class as it is choice." Klein writes that "the poorer women who will be using subsidies on [health insurance exchanges] are a much easier target" than wealthier women with employer-provided coverage (Klein, "Ezra Klein," Washington Post, 3/5).

~ "International Women's Day: The Enormous Benefits of Investing in Family Planning and Pregnancy Related Care," Sharon Camp, Huffington Post blogs: International Women's Day this year "coincides with the 15th anniversary of the adoption of the Beijing Declaration and Platform for Action, a historic pledge to make the recognition and fulfillment of women's rights a global priority," Camp, president and CEO of the Guttmacher Institute, writes. She adds, "The declaration makes clear that reproductive health is critical to the well-being of women and men, asserts all people's right to have access to family planning information and services, and underscores the importance of maternal and newborn health care." According to Camp, "Approximately 215 million women who want to avoid pregnancy are not using an effective method of contraception, and only about half of the 123 million women who give birth each year receive the antenatal, delivery and newborn care they need." She adds, "Millions of those women who experience major complications get no treatment and either die or suffer from severe and debilitating conditions, such as obstetric fistula." She continues, "It is clear that investing in women has vast benefits, not just for individuals and families, but for societies as a whole," concluding, "It can truly transform the future of developing nations" (Camp, Huffington Post blogs, 3/9).

~ "This International Women's Day, Let's Aim To End Maternal Deaths," Tamar Abrams, Huffington Post blogs: A December 2009 report from the Guttmacher Institute and the United Nations Population Fund shows that "[m]aternal deaths in developing countries could be slashed by 70% and newborn deaths cut nearly in half if the world doubled investment in family planning and pregnancy-related care," Abrams writes. She adds that the report "found that investments in family planning boost the overall effectiveness of every dollar spent on the provision of pregnancy-related and newborn health care." According to Abrams, delegates who plan to attend June's Women Deliver conference in Washington, D.C., "are determined to put maternal health high up on the agendas of leaders of nations large and small, developed and getting there." The delegates plan to ask for "$10 billion in additional funding for global maternal health annually, increasing to an additional $20 billion by 2015," Abrams says. She concludes, "We mustn't let this critical discussion get bogged down in ideology about abortion or contraceptives or politics" (Abrams, Huffington Post blogs, 3/5).

~ "Dirty Dozen: Does Stupak Really Have the Votes Needed To Sink Health Care?": Brian Beutler, Talking Points Memo's "TPMDC": Stupak is currently "holding health care reform hostage over the issue of abortion" and says "he can flip about a dozen 'yes' votes on health care (including his own) to 'no' votes if nothing is done about" abortion language in the Senate bill (HR 3590), Beutler writes. It is difficult to definitively identify these lawmakers, "[b]ut it is possible to whittle down a list of likely suspects," according to Beutler. He concludes that with Democratic leaders and "the White House teaming up to twist arm[s], it's hard to imagine all of Stupak['s] supporters will stick together" (Beutler, "TPMDC," Talking Points Memo, 3/8).

~ "Wreckonciliation": Rebecca Sive, RH Reality Check: Sive writes, "We, the women of America, are being told by those on-high, starting with those who might have been at the White House on International Women's Day, including Nancy Pelosi -- the most important woman in America right about now -- that American women's most fundamental right, our right to control our reproductive destiny, should be of no consequence in the effort to reform health care." Sive criticizes Pelosi for insisting that the health reform debate is "'not about abortion,' ... when even the most politically untrained, outside-the-Beltway bystander knows otherwise." Sive writes, "The future of ... health care reform has come down to this: can [Pelosi] and the White House come to a winning plan on how to deal with access to abortion?" Sive adds that regardless of how much ground Pelosi concedes to antiabortion-rights forces today, "they'll just ask for more tomorrow. That's how Washington works; that's how men in power work; that's how women in power who don't care about women work." Sive concludes, "That's wreckonciliation" (Sive, RH Reality Check, 3/9).

~ "Trouble for Mitt Romney? Mass. Health Plan Covers Abortion": Brian Montopoli, CBS News' "Political Hotsheet": "Mitt Romney's role in overseeing passage of a universal health care plan in Massachusetts appears likely to cause headaches for the former Republican governor should he make his widely expected run for the White House in 2012," Montopoli writes. He notes that other commentators are drawing attention to the fact that "all of the government-subsidized health care plans offered to low-income Massachusetts residents, under a program called Commonwealth Care, cover abortion." David Axelrod, a White House senior adviser, has called the Massachusetts health insurance law the "template" for Obama's reform plans. Montopoli writes, "All this appears to leave Romney on the wrong side of the issue." In response to criticism over the abortion issue, Romney spokesperson Eric Fehrnstrom said, "Court rulings in Massachusetts require state-subsidized health plans to offer abortion services. It's not something that Gov. Romney agrees with, but it's longstanding court precedent that predates his administration" (Montopoli, "Political Hotsheet," CBS News, 3/8).

~ "Abortion Will NOT Be a Deal Breaker," Linda Bergthold, Huffington Post blogs: Health policy consultant Bergthold writes, "If you only watched TV or surfed the net, you would think health reform hangs by a thread over abortion," when in fact it "does not." Bergthold says this misrepresentation occurs because abortion is "controversial" and abortion-rights opponents -- such as Rep. Bart Stupak (D-Mich.) -- "are the loudest voices" in the debate. Bergthold writes, "I do not believe that in the final analysis Stupak will have the votes to destroy health reform over the abortion issue. At least I want to believe that. " She adds, "But the media likes to play it up because it attracts an audience" (Bergthold, Huffington Post blogs, 3/6).

U.S. Maternal Mortality Rate Increases Over Last Decade

March 10, 2010 — The maternal mortality rate in the U.S. appears to have risen over the past 10 years, reaching a rate that is four times higher than the federal government's 2010 goal, the AP/Yahoo! News reports. In 2006, the last year for which nationwide data are available, about 13.3 maternal deaths occurred for every 100,000 live births, compared with around seven deaths per 100,000 births one decade before. U.S. officials had hoped to decrease the rate to about 3.3 deaths in 2010. In California, the state that most closely tracks maternal mortality data, there were about 16.9 maternal deaths per 100,000 live births in 2006, an increase from 5.6 maternal deaths per 100,000 births in 1996.

Mark Chassin of the Joint Commission called U.S. maternal mortality rates "unacceptable." He added, "Maybe as many as half of these [deaths] are preventable."

Maternal deaths are classified as those that occur within 42 days after delivery and are directly related to pregnancy or childbirth. The most common causes are deep vein thrombosis-caused pulmonary emboli, hemorrhage and uncontrolled blood pressure. For reasons that are unclear, black women are at least three times more likely to die from pregnancy complications than white women. For every maternal death, about 50 additional women experience serious complications during pregnancy or delivery, according to University of Louisville's Jeffrey King, a spokesperson from the American College of Obstetricians and Gynecologists.

Although it is unclear what is driving the overall increase, possible explanations include an increase in caesarean-section deliveries and a greater number of pregnancies among women older than age 30, the AP/Yahoo! News reports. One in five pregnant women is obese, which can lead to complications such as higher blood pressure and diabetes. In addition, the way maternal deaths are counted and tracked has changed over the last 10 years. However, only about 30% of the increase is likely due to changes in reporting methods, according to Elliott Main of the California Maternal Quality Care Collaborative (Neergaard, AP/Yahoo! News, 3/9).

Obama Steps Up Health Reform Message as Stupak Defends Efforts To Tighten Abortion-Coverage Restrictions

March 9, 2010 — As Democratic leaders attempt to resolve differences between the House (HR 3962) and Senate (HR 3590) health reform bills, President Obama on Monday held a rally in Pennsylvania to urge members of his party not to waver in their fight to enact the overhaul, the New York Times reports. During his speech, Obama said his critics have "warned us we may not win" and "argued now is not the right time for reform." He said, "My question to them is: When is the right time? If not now, when? If not us, who?" (Cooper/Herszenhorn, New York Times, 3/9).

Meanwhile, Rep. Bart Stupak (D-Mich.) held a town hall rally in his home district to defend his opposition to the Senate health reform bill's language on abortion coverage (Flesher, AP/Google, 3/9). Stupak argues that the Senate language does not go far enough to restrict abortion coverage in health plans that receive federal subsidies. Instead, he is advocating for more restrictive language that mirrors an amendment he sponsored in the House version of the bill. Stupak's amendment would prohibit insurance companies from selling plans that include abortion coverage to any people who receive help from the government in paying their premium. The Senate's language would allow such plans to offer the coverage, but to ensure that only private funds are used to pay for abortion coverage customers would be required to send in two premium payments each month -- one for abortion coverage and one for all other services (Women's Health Policy Report, 3/4).

Stupak said last week that he does not think House leaders have enough votes to pass the Senate version of the bill. However, he said Monday that he is "more optimistic than a week ago" that a compromise is possible. "The president says he doesn't want to expand or restrict current law (on abortion). Neither do I," Stupak said, adding, "That's never been our position." He added that he believes that there is "some language that we can agree on that hits both points."

Stupak said that he plans to resume discussions this week with House leaders on possible changes to the Senates health reform bill's language on abortion coverage (AP/Google, 3/9). According to CongressDaily, Stupak has been in talks with House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) about the language. A Waxman aide said Stupak provided eight pieces of legislation with abortion language Stupak considers acceptable.

House Abortion Opponents Confirm Support for Stupak

Democratic Reps. Dan Lipinski (Ill.) and James Oberstar (Minn.) have confirmed that they will join Stupak in opposing any final bill that includes the Senate language on abortion coverage. Stupak has claimed that there are 11 House members who will vote against health reform legislation because of the Senate language, CongressDaily reports.

The most likely strategy for passing health reform would be to have the House pass the current version of the Senate bill, then both chambers passing a budget reconciliation bill that would include changes to the Senate bill. Procedural rules for using the budget reconciliation process mean that such bills can only include provisions that directly affect the federal budget. Lipinski on Monday said he believes the most likely way to address the abortion issue would be to pass a third bill. He added, "It appears to me that abortion is not an issue that can be dealt with in a reconciliation bill. However, there are things that still surprise me, even though I was a political science professor prior to joining Congress" (Edney, CongressDaily, 3/9).

Associated Press Examines Abortion Coverage Debate

The AP/Yahoo! News on Tuesday featured a question-and-answer piece on the abortion-coverage debate and the possible effect it could have on health care reform efforts (Alonso-Zaldivar, AP/Yahoo! News, 3/9).

House Dems Discuss Abortion, Other Non-Budget Issues While Awaiting CBO Score on Health Reform

March 11, 2010 — On Wednesday, House Speaker Nancy Pelosi (D-Calif.) said lawmakers are focusing on resolving issues that fall outside the scope of the budget reconciliation bill -- legislation Democrats are drafting that would include changes to the Senate health reform bill (HR 3590), CQ Today reports. While Democrats are waiting for the Congressional Budget Office to score the various provisions in the budget reconciliation bill, lawmakers are "meeting on an ongoing basis to discuss non-CBO issues," she said. She added that she did not know when the CBO score would be available. According to CQ Today, the list of non-CBO issues "presumably" includes the matter of abortion-coverage language (Adams, CQ Today, 3/10).

Abortion coverage is not likely to be included in the budget reconciliation bill because procedural rules for using the budget reconciliation process do not allow inclusion of provisions that do not have a budgetary impact (Women's Health Policy Report, 3/10). Because budget reconciliation bills require only a simple majority, the process effectively shields it from a filibuster in the Senate.

Under the strategy being discussed, House Democrats are expected to try to approve the health care reform bill passed by the Senate in December. Both chambers would then pass the budget reconciliation bill, which would include changes to the Senate health care reform bill (Werner, AP/Yahoo! News, 3/11).

The Senate bill would allow health plans that receive government subsidies to offer abortion coverage. To ensure that only private funds are used to pay for abortion coverage, customers would be required to make two monthly payments -- one to pay for abortion coverage and one for everything else. Rep. Bart Stupak (D-Mich.) is leading some antiabortion-rights lawmakers in a push to include his more restrictive abortion amendment, which is included in the House bill (HR 3962). The amendment would prohibit health plans in the health care exchange receiving federal subsidies from offering abortion coverage.

Stupak claims that there are about one dozen House Democrats -- including James Oberstar (Minn.) and Daniel Lipinski (Ill.) -- who will vote against the Senate bill if the abortion-coverage language is not changed. However, Rep. Dale Kildee (D-Mich) on Tuesday said he believes he can support the Senate bill's approach to abortion coverage, despite his initial opposition to the language.

Rep. Marcy Kaptur (D-Ohio), who voted for the Stupak amendment in the House, said the Senate bill's language is "unacceptable" but stopped short of saying abortion would be the deciding factor in her vote. "I would not easily give over my vote for the bill if they don't fix that," Kaptur said, though she added that she also objects to the Senate bill's approach to costs and other issues.

On Wednesday, Stupak said that he is not sure what an abortion compromise would look like or whether abortion-related changes could be considered under budget reconciliation rules. Stupak added that his next step is to meet with House Energy and Commerce Committee Chair Henry Waxman (D-Calif.). Waxman on Tuesday indicated that he and Stupak have discussed the issue of abortion coverage but have not discussed the process of how the Senate bill's language could be changed (Benson, CQ Today, 3/10).

Stupak Primary Challenge Fueled by Abortion Stance

Although Stupak "has never been in serious danger" of losing his congressional seat, some Democrats in his district "are so angry" about his antiabortion efforts in the health reform debate "that he's facing a rare and long-shot primary challenge," the AP/Atlanta Journal-Constitution reports. Stupak's district comprises Michigan's entire Upper Peninsula and a significant area of its Lower Peninsula. The region has a significant Catholic population, and Stupak says his stance on abortion rights "reflects adequately" his constituency's views on abortion rights.

However, according to the AP/Journal-Constitution, the region's views on abortion rights are "mixed," and some critics have accused Stupak of trying to impose his religious beliefs on the larger U.S. population. On Tuesday, Connie Saltonstall -- a former Charlevoix County, Mich., commissioner -- announced that she would challenge Stupak for the Democratic nomination. Saltonstall said that Stupak's priorities are not in line with those of his constituents (Flesher, AP/Atlanta Journal-Constitution, 3/11).

'Rachel Maddow' Reports Only Four to Five House Members Back Stupak

MSNBC's "The Rachel Maddow Show" on Wednesday examined Stupak's claims that about one dozen lawmakers say they will oppose the Senate bill. Maddow reports that she spoke with a senior House leadership aide "whose job is ... to actually fact check what [Stupak] says, to see if he really does have those 12 votes he says he has." Maddow continued that "it turns out when Bart Stupak says 'at least 12,' what he really means is not really 12 at all." According to the senior leadership aide, an informal whip count revealed that no more than four or five House members are willing to support Stupak, Maddow said (Maddow, "The Rachel Maddow Show, MSNBC, 3/10).

Kaiser Health News Profiles USCCB's Doerflinger

Richard Doerflinger -- associate director of the U.S. Conference of Catholic Bishops' Secretariat of Pro-Life Activities -- "has emerged as a major player in the health care debate, one likely to play a pivotal role in the outcome," Kaiser Health News reports. Doerflinger is leading USCCB's opposition to the Senate bill's abortion-coverage language. Although the Catholic Church has a long history of supporting universal health care, Doerflinger is "sending a clear message: If Democrats want to succeed, they must include the House provision, or something equally restrictive, on abortion," according to KHN.

Some abortion-rights groups have accused Doerflinger and USCCB of using their abortion agenda to derail health care reform. Laurie Rubiner, vice president for public policy for the Planned Parenthood Federation of America, said, "No one else drew a line in the sand" (Parker, Kaiser Health News, 3/10).

W.Va. Panel Sends Ultrasound Abortion Bill to Full House

March 11, 2010 — The West Virginia House Judiciary Committee on Wednesday approved a bill (HB 4517), including two new amendments, that would alter an existing state abortion law by requiring that that women be able to view an ultrasound image of their fetus before an abortion, the Charleston Daily Mail reports (Rivard, Charleston Daily Mail, 3/11). According to the bill text, an ultrasound would be available when "the standard of care dictates" (Bill text, 2/16). The requirement would only apply in cases in which the provider has determined that an ultrasound is medically necessary. The bill now proceeds to the full House (AP/Charleston Gazette, 3/11).

The bill would add to a law, which was approved several years ago, that requires abortion providers to notify a woman at least one day before an abortion that she could be eligible for public assistance, that the father is liable to help support the child and that she has the right to review printed materials about fetal development (Charleston Daily Mail, 3/11). Abortion providers also must offer patients information on pregnancy, prenatal care, risks of abortion and alternatives to the procedure. In most cases, providers are permitted to provide that information by telephone (Women's Health Policy Report, 3/10).

On Wednesday, the committee amended the bill to eliminate criminal penalties in the existing law for physicians who violate its requirements. Physicians could still be reprimanded by the state's medical licensing board.

Abortion-rights advocates had fought for the removal of the sanctions. Margaret Chapman Pomponio -- executive director of West Virginia FREE, an abortion-rights group -- said that despite the amendment, the bill "continues the state's interference in private medical decisions." She added, "The penalties were pretty hard fought at that point, so, frankly, I was surprised the [antiabortion] lobby agreed to that amendment."

The committee also approved an amendment that would require women to sign a form stating that they have been informed of the option to view the ultrasound image (Charleston Daily Mail, 3/11).

Abortion-Rights Advocates Have 'Right To Hate' Woman's Decision To Describe Abortion on Twitter, Opinion Piece Says

March 11, 2010 — Abortion-rights supporters "who came from generations where women had no legal abortion choices understand how precious the right to choose is," Mary Ann Sorrentino -- who served as executive director of Planned Parenthood of Southern New England from 1977 to 1987 -- writes in a Salon opinion piece. However, 27-year-old Angie Jackson's decision "to use Twitter as a public stage for her private decision to terminate a pregnancy" through medical abortion, is "[a]t its worst, ... self-serving, exhibitionist and selfish," Sorrentino says. "At best, it has 'bad judgment' written all over it," she adds. Sorrentino notes that Jackson has said she has about 800 Twitter followers and is hoping to publish a book.

Jackson has said she decided not to continue the pregnancy because of the difficult pregnancy she experienced with her now-four-year-old son, who has special needs, Sorrentino writes. "If this is true, and her decision about ending her childbearing is solid and responsible, one has to wonder why she didn't just have a tubal ligation," which would have "sav[ed] the rest of the universe the anguish of assisting at such a personal and difficult moment," according to Sorrentino.

Jackson "ha[s] the right to choose" medical abortion and write about the process, but "many of us who have spent our lives on the front lines of the abortion debate also have the right to hate the fact that she chose to do this," Sorrentino writes. The "right we were fighting so hard for ... was based on what the Supreme Court called 'privacy," she continues. "We wanted a woman to be able to make personal decisions about their pregnancies in the privacy of their most intimate circles, ... if she chose," or "she could decide as a panel of one and discuss it with no one," Sorrentino says (Sorrentino, Salon, 3/9).

Home-Administered Misoprostol Safe Abortion Option for Women Up to 63 Days Pregnant, Study Finds

March 11, 2010 — A team of Swedish researchers concludes that taking misoprostol at home as part of a medical abortion regimen is a safe option for women who are 50 to 63 days pregnant, according to a study published in the journal Human Reproduction, Reuters reports. The study's authors said that their research is the first published report to examine at-home medical abortion in women who were more than 49 days pregnant.

In the U.S., women have been permitted to take physician-prescribed misoprostol at home since 2000. Mifepristone -- the first drug in the medical abortion regimen, which is taken three to four days prior to misoprostol -- is administered at a clinic, physician’s office or hospital. Most European countries require that women take both drugs in a clinic, doctor's office or hospital, although home administration is permitted in Sweden, Reuters reports.

For the study, Helena Kopp Kallner of the Karolinska Institutet in Stockholm and colleagues followed about 3,000 medical abortion patients at their clinic in Sweden from January 2004 through April 2007. Of the women, 395 opted for home administration of misoprostol. Of those 395 women, 203 were fewer than 50 days pregnant and 192 were 50 to 63 days pregnant. The home-administration group took mifepristone orally at the clinic and was given four misoprostol tablets to administer vaginally up to two days later.

Among women who were fewer than 50 days pregnant, 199 experienced complete abortions, while 186 of the women who were between 50 and 63 days pregnant experienced complete abortions. Ten women required surgery. About six in 10 women in both groups needed extra pain medication. The study concluded that home administration of misoprostol is "safe and highly acceptable also to women with a gestational length of 50-63 days as compared with shorter gestations" (Reuters, 3/9).

Newsweek Examines Role of New Female Condom in Efforts To Combat Spread of HIV in D.C.

March 11, 2010 — Women's health experts are watching closely to see whether a recent grant to provide no-cost female condoms in Washington, D.C., will "really make a difference" in the area's HIV/AIDS rate among women, Newsweek's Kate Dailey writes. The goal of the program is to empower women to take control of their own health and safety. The $500,000 grant from the MAC AIDS Fund will allow health centers in the district to promote and distribute the latest version of the female condom, FC2, which FDA approved in March 2009. The female condom can be inserted several hours before intercourse, allowing a woman to protect herself without having to persuade the man with whom she's sleeping to change his behavior. The program aims to reduce the district's HIV transmission rate, particularly among women. HIV is the leading cause of death among black women ages 24 through 39 in D.C. About three percent of black women in D.C. have HIV, compared with a rate of 0.7% for the U.S. population.

FC2 "offers several advantages over the original," including a lower cost of 82 cents per condom, Dailey writes. Shannon Hader, director of the HIV/AIDS administration at the D.C. Department of Health, said the lower cost "reduced wholesale prices to about a third of the initial price, which made it feasible to add onto our condom-distribution program," even after the MAC grant ends. The new female condom also is expected to be quieter and more comfortable than the original.

According to Dailey, although female condoms "have proved to be one of the best ways of reducing HIV transmission among women," their use "never took off." A 2002 Centers for Disease Control and Prevention study found that only 2% of women in the U.S. had ever used the female condom, and experts believe the rate has not changed significantly in the years since, Dailey writes. Vanessa Cullins, medical director for the Planned Parenthood Federation of America, said, "More than likely, giving out the condoms and making them easily available is not going to be enough for a lot of people." Cullins added, "Some people will take advantage of the fact that the condoms are easily available, but others will need to have a conversation, not only with partners and potential partners, but also with friends about female condoms."

Dailey continues, "It won't be immediately apparent as to whether this partnership will lower HIV rates in the district," but the Department of Health "has established some short-term benchmarks of progress." Hader said, "We hope that by adding yet another tool, not just more people will be using female condoms, but that people will become more regular users of any condom in general" (Dailey, Newsweek, 3/10).

Gonorrhea Cases Rise Sharply in Alaska

March 11, 2010 — Alaska health officials have reported that the state's gonorrhea rates increased by 69% in 2009 after remaining steady for years, the Anchorage Daily News reports. Susan Jones of the Alaska Department of Health and Social Services said the increase is the biggest one-year jump since the 1970s.

Gonorrhea is sexually transmitted and can lead to pelvic inflammatory disease, infertility and miscarriages in women; eye problems in newborns; and infections in men. It is frequently accompanied by chlamydia and can be treated with antibiotics (Shinohara, Anchorage Daily News, 3/10). Many people who are infected with gonorrhea have no symptoms or symptoms that do not appear for about 30 days. In women, the initial symptoms can include painful urination, increased vaginal discharge or vaginal bleeding between periods. In men, symptoms include a burning sensation during urination, discharge from the penis or painful, swollen testicles.

Details of Report

There were 997 cases of gonorrhea reported in 2009, an increase from 578 in 2008 (Joling, AP/Connecticut News-Times, 3/10). The rate of gonorrhea infections was 144 cases per 100,000 residents, up from 85 cases per 100,000 residents in 2008. According to Jones, gonorrhea rates increased in every area of the state except for Interior Alaska (Anchorage Daily News, 3/10). Men and women ages 20 through 24 had the highest infection rates. Women accounted for slightly more than half of the cases (AP/Connecticut News-Times, 3/10).

Jones said Alaska's gonorrhea rate has been in the middle range of all states in recent years. The 2009 rates could place Alaska among the top 10 states with the highest rates of sexually transmitted infections, according to Jones.

Reasons for Increase Unclear

State officials said there is no known explanation for the sharp increase. Jones said the rise is not the result of increased testing because the number of tests has been consistent. She also said some health providers have noted that the type of gonorrhea that is most prevalent throughout the state has milder symptoms than in past outbreaks (Anchorage Daily News, 3/10). "In some cases, the symptoms are mild enough, or not annoying enough, that people are not coming in to seek care, or delaying coming in," Jones said, adding, "So that means they have gonorrhea for a long period of time and are able to transmit it more"(AP/Connecticut News-Times, 3/10).

Antiabortion Amendments Stalling Unrelated Bills in Ky. House

March 11, 2010 — Two Republican members of Kentucky's House are attaching antiabortion-rights amendments to several unrelated bills that are awaiting a chamber vote, a move that is threatening to derail changes related to children's Medicaid coverage, among other things, the Lexington Herald-Leader reports. The amendments -- sponsored by Reps. David Floyd and Tim Moore -- would require abortion providers to conduct an ultrasound and show the woman the image. The amendments also would require counseling prior to an abortion.

As of Tuesday evening, at least six bills were stalled because of the amendments. Democratic leaders are sending bills back to committee to avoid floor fights over the abortion amendments. Floyd, the House minority whip, previously sponsored a bill (HB 373) with the same language as the amendments. That bill did not make it out of a February House Health and Welfare Committee hearing, the Herald-Leader reports. He claims that if the House were allowed to vote on the amendments, they would pass by a five-to-one margin.

Backers of the derailed bills say that Floyd and Moore are using the amendments to stall legislation that has broad support. Terry Brooks, executive director of Kentucky Youth Advocates, said, "I find it sadly ironic that the same voices that want to protect unborn children are willing to put children as risk after they are born." In addition, some antiabortion-rights groups are criticizing Floyd and Moore's strategy. Robert Castagna, executive director of the Catholic Conference of Kentucky, said that the amendments "are not something that we would be endorsing" (Cheves, Lexington Herald-Leader, 3/10).