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February 2012

• Reproductive health a casualty of Burma's conflict
  Comprehensive new study finds extensive harm in conflict-affected regions including widespread injury from unsafe birthing and abortion
  February 6, 2012 – A new report released today by Ibis Reproductive Health and the Global Health Access Program (GHAP) documents a widespread public health emergency in populations affected by the decades-old conflict in eastern Burma. Its consequences include maternal mortality rates that dwarf the rates in Thailand and Burma (Myanmar) as a whole, leaving women in eastern Burma with the worst pregnancy outcomes anywhere in Asia.
  
  According to Dr. Angel Foster, DPhil, MD, of Ibis and the University of Ottawa, “Our report finds that millions of Burmese and ethnic minorities both inside Burma and along the Thai border have limited or no access to family planning, safe abortion, and general reproductive health care. The toll on women has been particularly severe. Negative effects include high numbers of unplanned pregnancies — and, consequently, high rates of maternal mortality and unsafe abortions. In fact, post-partum hemorrhage and unsafe abortion are the leading causes of maternal death and injury.”
  
  The absence of health care infrastructure inside eastern Burma, as well as for those Burmese living illegally as migrants in Thailand, has produced a kind of reproductive health “perfect storm.” Notes Foster, “Since denial of health care has been an official policy of the Burmese military in ethnic areas, women and men, especially adolescents, know little about family planning practices and voluntary sterilization."
  
  Read the full press release here.
  Download the full report and executive summaries and key findings in Burmese, English, Karen, and Thai here.
  
  For more information, contact Cari Sietstra.
  

December 2011

• A declaration in support of a global campaign for safe abortion access
  2011 International Conference on Family Planning, Dakar, Senegal
  December 29, 2011 – The need to integrate safe abortion care within family planning programs and comprehensive sexual and reproductive health and rights has been a recurring theme in the 2011 International Conference on Family Planning.
  
  Despite commitments from ICPD, CEDAW, UN Millennium Development Goals 5 and 5(b), and international women’s conferences, women around the world continue to suffer death and disability due to unsafe abortion. Approximately 22 million unsafe abortions take place globally, contributing to high rates of maternal mortality and morbidity. Each one of these deaths and disabilities is unacceptable and preventable.
  
  Many of these tragic deaths and disabilities can be prevented with the provision of comprehensive, safe abortion care. Abortion care and family planning services are intertwined; they are integral components of comprehensive women’s sexual and reproductive health and rights. These services should be provided to all women irrespective of age, marital status, color, ethnicity, religion, gender and sexual orientation, socio-economic status, and where they live and work.
  
  Young women account for almost half of the estimated unsafe abortion-related deaths. Changing demographics will result in a significantly larger proportion of the population being under 25 years old. We need to take immediate action to save young women’s lives so they are able to achieve their true potential and assume rightful leadership in social and economic development.
  
  To respect and fulfill women’s rights and facilitate all women’s access to comprehensive abortion care including family planning services, states are called to decriminalize abortion as per the Bejing Platform for Action and the recent statement to the UN General Assembly by the Special Rapporteur for Health of the UN Human Rights Council.
  
  More political and financial commitment to comprehensive abortion care is required to ensure the fulfilment of goals set by the international community.
  
  Abortion has been systematically neglected in many sexual and reproductive health and rights (SRHR) strategies and programmes. We call for the inclusion of high-quality, accessible, and affordable abortion care in all global SRHR programmes and guaranteed access to the full range of safe abortion care for all women.
  
  This declaration was prepared by networks and agencies participating in the 2011 International Conference on Family Planning that are working to advance a global campaign for safe abortion access, including: African Network for Medical Abortion (ANMA); Asia Safe Abortion Partnership (ASAP); Bixby Center for Population, Health and Sustainability at the University of California, Berkeley; Family Care International (FCI); Ghana Health Service, Ministry of Health; Gynuity Health Projects; Ibis Reproductive Health; International Consortium for Medical Abortion (ICMA); International Planned Parenthood Federation (IPPF); Ipas; Latin American Consortium against Unsafe Abortion (CLACAI in Spanish); Pathfinder International; Planned Parenthood Global; Population Council; Venture Strategies for Health and Development (VSHD); Venture Strategies Innovations (VSI) and Women Deliver.
  
  A similar declaration was prepared and read by the following partners during the 6^th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR) held in Yogyakarta, Indonesia in October 2011: Asia Safe Abortion Partnership (ASAP), Concept Foundation, Women on Waves, Women’s Global Network for Reproductive Rights (WGNRR) and the International Planned Parenthood Federation East and SE Asia and Oceania Region (IPPF-ESEAOR) and South Asia Region (IPPF-SAR).
  
  For more information, please contact:
  Dr. Selma Hajri, ANMA Co-Chair at selmahajri@gmail.com
  Dr. Getachew Bekele, ANMA Co-Chair at getachew.b2000@yahoo.com
  

• Ibis Reproductive Health surprised, disappointed by Secretary Sebelius’s overruling of FDA Plan B One-Step decision
  December 7, 2011– Ibis Reproductive Health is surprised and extremely disappointed that Department of Health and Human Services Secretary Kathleen Sebelius stepped in and overruled the Food and Drug Administration’s (FDA) decision to make Plan B One-Step available over the counter (OTC) for all women. The Secretary’s action is an unprecedented interference in the FDA’s expert review process. Data convincingly show that Plan B One-Step is safe for women of all ages and that the instructions on the label are easy to follow. The Secretary provided no explanation of what risk or concern she has for younger teens, and she inserted her own opinion in the place of scientific expertise at the Center for Drug Evaluation and Research at the FDA.
  
  Levonorgestrel emergency contraception (EC) is safe and offers women a second chance to prevent pregnancy after unprotected sex. ALL women who are at risk of pregnancy—no matter how young or old—should have access to EC with as few barriers as possible in order to prevent unintended pregnancy and protect their health. This decision affects and harms ALL women because it keeps EC behind the counter, instead of making it available on the drugstore shelf, 24/7, so women can access it as soon as they need it.
  
  Secretary Sebelius should let the FDA do its job. We at Ibis are dismayed that the Obama administration is not keeping its promise to make decisions based on the best science. We call on Secretary Sebelius to allow the FDA to move forward with its approval of full-OTC access to Plan B One-Step and for President Obama and this administration to stand up for science and for women.

October 2011

• Ibis submits comments on HHS guidelines for coverage of preventive services
  October 3, 2011– In two letters to Secretary Kathleen Sebelius, Ibis Reproductive Health commented on the recently released HHS guidelines for women’s preventive services and contraception coverage under health care reform.
  
  In the first letter, Ibis urged removal of the clause in the Amendment for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act (PPACA) that would allow some religious institutions to deny contraceptive coverage to employees. Ibis drew on its previous research on health care reform in Massachusetts, which showed that the religious exemption policy in Massachusetts can create significant logistical and financial barriers to contraceptive access. Ibis concluded the letter by stating that women who are insured by religiously affiliated institutions should not be denied opportunities to access contraception and improve their lives because of religious exemptions.
  
  In the second letter, Ibis applauded the IOM for requiring coverage for FDA-approved contraceptives and called for clarification on how the guidelines will be implemented for over-the-counter FDA-approved contraceptives. Ibis recommended that the IOM not require prescriptions for over-the-counter contraception, as that may act as a barrier to access.
  

September 2011

• Advocates, health care providers, and women step forward to ensure US women can access Medicaid funding for abortion in cases of rape, incest, and life endangerment
  The broken Medicaid system under the Hyde Amendment fails women who are legally entitled to abortion coverage under current law
  September 30, 2011 – A combination of advocacy, legal, and grassroots strategies can help improve access to Medicaid coverage for US women who seek abortions in cases of rape, incest, or life endangerment, according to “Strategies for securing funding for abortion under the Hyde Amendment: A multistate study of abortion providers’ experiences managing Medicaid,” by researchers at Ibis Reproductive Health published online this month in the American Journal of Public Health.
  
  Today is the 35^th anniversary of the Hyde Amendment, which since 1976 has prevented women enrolled in the US Medicaid program from using their health insurance for abortion care in most circumstances. The policy currently stipulates that when a pregnancy results from rape or incest, or when it endangers a woman’s life, federal Medicaid coverage should be available. Most US states follow the federal example and restrict Medicaid coverage of abortion to the circumstances outlined by the Hyde Amendment.
  
  But findings from almost 50 in-depth interviews with abortion providers in 11 states that restrict abortion coverage to only the cases permitted under the Hyde Amendment suggest that limiting the circumstances that qualify for coverage effectively leads to prohibitions on coverage in all cases. Despite the exceptions carved out by the Hyde Amendment, most abortion providers in states that restrict Medicaid coverage confront considerable difficulty obtaining reimbursements for abortions provided to women in cases of rape, incest, or life endangerment.
  
  Only 37% of the 1,165 abortions provided in cases of rape, incest, or life endangerment included in Ibis’s research were ultimately covered by Medicaid. Consequently, women, abortion providers, and abortion funds covered the costs of 736 abortions that should have been paid for by Medicaid.
  
  The few abortion providers who were successful at securing Medicaid coverage for women in these cases developed a number of strategies to overcome the systemic barriers to reimbursement. Developing relationships with Medicaid staff helped make the claims process easier and increased the number of qualifying abortions that were covered. Establishing strong and savvy billing departments also increased providers’ success working with Medicaid. Some providers found that Medicaid was more responsive when women themselves contacted Medicaid to advocate for coverage of their cases, but providers worried that women struggling to cope after a rape or with a severe illness might feel overwhelmed and further victimized by the process of negotiating with Medicaid.
  
  Broad-based, state-level interventions appeared to hold the most promise for increasing women’s access to Medicaid coverage. The collaborative efforts of advocates, abortion providers, and legal experts in some states led to significant improvements on the ground, as well as at the policy level. In one state, a group came together to implement an effective statewide program of activities that included simplifying Medicaid claims forms and creating educational materials that explain when Medicaid should cover abortion care. These activities built on a legal victory that removed burdensome requirements that women submit paperwork “proving” the circumstances of their abortions (such as a police report in cases of rape).
  
  “Ibis’s research has shown that in states where abortion coverage is limited to the Hyde Amendment exceptions, it is extremely challenging for providers to get reimbursed. Medicaid is a critical source of health insurance for millions of American women, but federal and state restrictions on abortion coverage are unjust, and make it very difficult for women to access the abortion care they need,” said principal investigator Kelly Blanchard, president of Ibis.
  
  “As we mark the 35^th anniversary of the Hyde Amendment, this study provides important insight into why the policy must be overturned. At the same time, it shows that while we work to repeal restrictions on abortion coverage, there are many things we can do to remove some of the obstacles that women are facing right now.” 
  
  Ibis has conducted several studies evaluating the impact of Medicaid restrictions on US abortion providers and women. We will soon release resources summarizing our findings and ways that advocates, women, abortion providers, and policymakers can take action individually and collectively to improve women’s access to abortion care. For more information, please contact Amanda Dennis.
  
  References:
  
  Dennis A, Blanchard K, Córdova, D. Strategies for securing funding for abortion under the Hyde Amendment: A multi-state study of abortion providers’ experiences managing Medicaid. American Journal of Public Health. Online ahead of print September 22, 2011: e1–e6. doi:10.2105/AJPH.2011.300212.
  
  Kacanek D, Dennis A, Miller K, Blanchard K. Medicaid funding for abortion: Providers’ experiences with cases involving rape, incest and life endangerment. Perspectives on Sexual and Reproductive Health. June 2010; 42(2).
  
  Click here to read the article abstract.
  Click here to request a copy of the article.
  
  
• Second-trimester abortion must be addressed in global strategies to eradicate unsafe abortion and reduce maternal mortality 
  September 22, 2011 – Unsafe abortion kills 47,000 women every year and leads to complications for millions of women. The risk of death and disability for women undergoing unsafe abortion in the second trimester is particularly high, say Dr. Lisa Harris of University of Michigan and Dr. Dan Grossman of Ibis Reproductive Health in a commentary published in the International Journal of Gynecology and Obstetrics. Therefore, efforts to reduce unsafe abortion and improve maternal health cannot neglect second-trimester services.
  
  Although second-trimester abortions account for a minority of all abortion procedures, unsafe second trimester abortions are the cause of the majority of serious abortion-related complications and death, especially in low-resource settings where the vast majority of unsafe abortions take place. Yet in many countries second-trimester services are not readily available, owing to a lack of trained providers and widespread stigma. Even in countries where later abortion is legal, women still face barriers in accessing the service.
  
  In order to address these barriers, more providers should be trained to perform second-trimester abortions and second-trimester services must be mainstreamed into health services around the world. Access to safe and acceptable medical induction could be greatly expanded by registering mifepristone for second-trimester use and making the drug widely available. In addition, research is urgently needed to determine the extent of the unmet need for safe second-trimester services and to address gaps in clinical knowledge, especially about how to best scale up these services in low-resource settings. Ibis is currently conducting research on these topics and will soon share results from a South Africa study. 
  
  While one strategy to reduce unsafe second-trimester abortion could be to help women access abortions earlier in their pregnancies, data show that the rate of second-trimester abortion has remained relatively constant over time, despite advances like the introduction of medication abortion, which has allowed more women to access abortions before nine weeks of pregnancy. Efforts should continue to help women get earlier abortions, but the need for second-trimester abortion will not go away. In order to save women's lives and improve women's health everywhere, second-trimester abortion must be included in global and local strategies to improve access to safe abortion.
  
  Citation: Harris LH, Grossman D. Confronting the challenge of unsafe second-trimester abortion. Int J Gynaecol Obstet 2011;115(1):77-9
  
  Click here to read the article abstract.
  Click here to request a copy of the article.

August 2011

• How often and under which circumstances do Mexican pharmacy vendors recommend misoprostol to induce an abortion?
  August 1, 2011 – Misoprostol has been sold in Mexican pharmacies since 1985. However, little is known about pharmacy vendors’ recommendations for misoprostol use as an abortifacient, especially after the legalization of first-trimester abortion in Mexico City in April 2007.
  
  Ibis Project Manger Diana Lara, in collaboration with researchers from the Population Council Mexico office, sent three types of simulated clients, a young woman aged 18-25, an adult woman aged 26-35, and an adult man aged 20-30, to 192 pharmacies in eight cities, including Mexico City. Each simulated client was trained to ask for a drug to take to interrupt a pregnancy (the male simulated clients asked for the drug on behalf of a girlfriend), and then to ask follow up questions based on the pharmacist’s response. The simulated clients were also trained to ask about misoprostol directly (using the commercial name Cytotec) if the pharmacist did not mention it spontaneously.
  
  The study team obtained information from 558 client-vendor interactions. In 24% of them, the vendors spontaneously recommended a drug when the simulated client asked for a drug to induce an abortion. Almost half of all vendors who made these spontaneous recommendations recommended Cytotec alone while 11% recommended taking other brands of drugs that contain misoprostol, 22% recommended a combination of abortifacient and nonabortifacient drugs, and 18% recommended nonabortifacient drugs.
  
  In 78% of the client-vendor interactions, the vendor provided some information about Cytotec. Cytotec was recommended without a prompt from the simulated client in 18% of the encounters, while in 60% the vendor provided information after the client asked for it. However, in the majority of interactions, vendors provided incomplete information about dosage, administration, side effects, and complications. Only 15% of vendors recommended a correct dose.
  
  While Cytotec was the most common drug mentioned spontaneously by vendors, the second most recommended drug was emergency contraception (EC), even when clients stated that they had a positive pregnancy test. Emergency contraceptive pills contain high doses of the hormones found in oral contraceptive pills and are used post-coitally to prevent pregnancy. EC is not an abortifacient.
  
  This study illustrates that information about misoprostol is commonly given by Mexican pharmacists, but that they do not always provide correct information. Therefore, the study recommends that more should be done to educate women about safe and effective misoprostol use.
  
  “How often and under which circumstances do Mexican pharmacy vendors recommend misoprostol to induce an abortion?” Diana Lara, Sandra G. Garcia, Kate S. Wilson, Francisco Paz. International Perspectives on Sexual and Reproductive Health 2011;37(2):75-83.
  
  Click here to read the article abstract.
  Click here to request a copy of the article.
  
  

July 2011

• New research finds providing medical abortion using telemedicine is effective, safe, and acceptable to women
  Study has implications for overcoming barriers to abortion access in the US
  July 21, 2011 — In 2008 Planned Parenthood of the Heartland in Iowa began offering medical abortion with mifepristone and misoprostol at outlying clinics without a doctor on site using telemedicine. A new study led by Ibis Reproductive Health found that women who obtained medical abortion through the telemedicine service were just as likely to have a successful abortion as women who had an in-person visit with a doctor, and that telemedicine clients were more likely to say they would recommend the service to a friend compared to clients who met with the doctor in person. Medical complications were rare in both groups and women who used the telemedicine service were no more likely to have a complication than women who saw a doctor in person.
  
  Researchers, led by Dr. Daniel Grossman, Senior Associate at Ibis Reproductive Health, followed 450 women between 2008 and 2009 who obtained medical abortions at six Planned Parenthood of the Heartland clinics in Iowa. Half of the women in the study accessed the services through an in-person physician visit and half through a telemedicine visit where the woman spoke to the doctor using video teleconference equipment on a secure dedicated data connection.
  
  All women had an ultrasound performed by a trained technician, received information about medical abortion, and underwent standard informed consent for the abortion. A physician then reviewed the patient’s medical history and ultrasound images, and met with the woman either in person or using video teleconference equipment. The physician determined whether the woman was eligible for medical abortion. In-person patients were handed the mifepristone and misoprostol tablets by the physician. For telemedicine patients, the physician entered a computer password to remotely unlock and open a drawer in front of the patient and her nurse containing the tablets. In all cases, the physician then observed the woman swallow the mifepristone (either in-person or via the video teleconference), and gave her instructions for taking the remaining tablets at home. 
  
  According to the study findings, 99% of women who obtained medical abortions through telemedicine had a successful abortion, compared to 97% of in-person patients (there was no statistical difference in likelihood of success). Ninety-one percent of all clients were very satisfied with their abortion, although telemedicine clients were more likely than in-person clients to say that they would recommend the services they received to a friend. 
  
  The researchers also analyzed all of the data on adverse events for the more than 3,500 women who underwent medical abortion between July 2008 and October 2009. Few women (1.3%) had a complication related to medical abortion, and there was no difference in the likelihood of adverse events between in-person and telemedicine patients. Most of these adverse events were ongoing pregnancies, but they also included a few cases of blood transfusion or other treatment in the emergency room. “The study shows that medical abortion can be safely offered through telemedicine with the same low risk of complications that has been reported in the literature,” said Grossman.
  
  All patients were told at the time they scheduled their appointment whether they would receive abortion services through telemedicine or not. Twenty-five percent of telemedicine clients said they would have preferred being in the same room with the doctor, with young women, women with a high school education or less, and women without children significantly more likely to prefer in-person communication. “These findings highlight the importance of informing women about what the telemedicine service involves so patients can weigh the options about which service they prefer,” said Grossman. “While a number of the women would have preferred being in the same room with the doctor, it seems that the convenience of having an abortion closer to their home or possibly getting an appointment sooner were even more important factors.”
  
  The study results indicate that telemedicine for medical abortion is both effective, safe, and highly acceptable among women. “In rural areas in the United States, women may have to travel for hours to see a physician, and this can be an insurmountable barrier to care. Being able to meet with a doctor using telemedicine could help address disparities in access to health care and improve women’s health and well-being,” Grossman says.
  
  “Effectiveness and Acceptability of Medical Abortion Provided through Telemedicine,” Daniel Grossman, Kate Grindlay, Todd Buchacker, Kathleen Lane, Kelly Blanchard. Obstetrics and Gynecology 2011;118:296-303.
  
  Click here to read the article abstract.
  Click here to request a copy of the article.
  
  For more information, contact Britt Wahlin, 617-349-0040, (after business hours: 617-549-2852)
  
  
• First Study of US Military Women’s Experiences Seeking Abortion Care During Overseas Deployment Shows Barriers that Impact Women’s Careers and Health
  July 10, 2011 — Between 19,000 and 23,000 US servicewomen have unintended pregnancies each year, but little is known about their experiences, particularly during deployment. In the first study to investigate US servicewomen’s experiences seeking abortion during deployment, researchers at Ibis Reproductive Health found that US military women and dependents face significant barriers when trying to access abortion care, including legal and logistical impediments to services in the country where they are based, and difficulties accessing abortion elsewhere due to fear of negative career impacts, confidentiality concerns, and the narrow timeframe for early abortion. With no perceived alternatives, some women reported considering unsafe methods to terminate the pregnancy themselves. The study results are reported in the July-August, 2011, issue of Women’s Health Issues.
  
  Current law prohibits abortions for US military women and dependents at military facilities in most cases, even if women pay for the procedure themselves. The implications of these abortion restrictions are most salient for women deployed overseas, who have few or no safe abortion options without leaving their deployment.
  
  Researchers, led by Dr. Daniel Grossman, Senior Associate at Ibis Reproductive Health, examined the de-identified consultation data and user queries from 130 US military women and dependents stationed overseas between 2005 and 2009 who were seeking information on abortion from an online source. Grossman and colleagues analyzed information about women’s pregnancy circumstances, reasons for choosing abortion, and experiences seeking services during deployment.
  
  “In our research, women with an unintended pregnancy had a strong desire to complete their tour of duty and continue serving their country, and they did not want to interrupt their service by returning home because of the pregnancy,” Grossman said. “Beyond this, their reasons for seeking abortion care were similar to those of most US women: because it’s the wrong time in their life to have a child, because they don’t have the financial resources to support a child, because they’re worried the pregnancy will adversely affect their career, or because they were raped, among other reasons.”
  
  The majority of women in the study were stationed in countries where abortion is prohibited. In Iraq and Afghanistan, for example, abortion is banned except to save the life of the woman. Women also said they were unable to travel in-country to access care off-base due to combat operations or other unsafe conditions. Many women, some of whom had been raped, reported feeling “desperate” because they did not have safe abortion options through the military or in the country where they were stationed.
  
  “A woman’s only option to access safe abortion care may be to take personal leave to return home and pay for the service herself,” Grossman said. “As the women in this study described, this makes it difficult for a woman to keep her decision confidential, it can hurt her career, and it can delay accessing services.” In some cases, with no perceived alternatives, women reported considering unsafe methods to terminate the pregnancy themselves.
  
  “The findings of this study give voice to US servicewomen deployed overseas who have faced an unintended pregnancy and had to confront the reality of not having safe or confidential abortion options,” says Kate Grindlay, co-author and a Project Manager at Ibis Reproductive Health. “Their stories show very clearly that the needs of women in the US military are not being met under current policies.” In June of this year, Congresswoman Louise Slaughter (NY) and Senator Kirsten Gillibrand (NY) introduced the MARCH for Military Women Act, which would lift the statutory ban that denies US servicewomen coverage for abortion care in cases of rape or incest and prevents women in the military from using private funds to access abortion services at US military facilities. “This bill would protect servicewomen’s health and careers, enable them to continue the job they were enlisted to do, and would provide the comprehensive health care that US military women need and deserve,” said Grindlay.
  
  This research was supported by a grant from The Wallace A. Gerbode Foundation.
  
  

  “Abortion Restrictions in the U.S. Military: Voices from Women Deployed Overseas,” Kate Grindlay, Susan Yanow, Kinga Jelinska, Rebecca Gomperts, Daniel Grossman, Women’s Health Issues 2011 Jul-Aug;21(4):259-64.
  
  Click here to read the article abstract
  Click here to request a copy of the article
  
  For more information, contact: Kate Grindlay, 617-349-0053

June 2011

• Ibis congratulates Senior Associate Angel Foster on her new position as Echo Endowed Chair of Women’s Health Research at the University of Ottawa
  June 10, 2011 — Although she will be missed, Ibis is pleased to announce Dr. Angel Foster’s new position at the University of Ottawa, where she will be continuing her work on reproductive health in the Middle East and North Africa, as well as expanding her research to include work on reproductive health policy in Canada.
  
  Ibis would like to take this opportunity to celebrate Dr. Foster’s extraordinary contributions. Throughout her eight years at Ibis, Dr. Foster has been a key team member for a wide range of projects, including the Ellertson Fellowship, and research on health care reform and health professionals training; Angel also lead a cutting edge program of work on reproductive health in the Middle East and North Africa which she will further develop in her new position. Dr. Foster has a unique combination of social science and medical training, language skills and experience working in the MENA region and it has been a pleasure to work with her. We wish her all the best in her new position and look forward to finding new ways to collaborate
  
  To read the University of Ottawa’s announcement, click here.

 

• Ibis Senior Associate Dan Grossman featured in NPR story on anti-abortion rights groups' efforts to redefine when life begins to restrict access to a range of reproductive health services
  June 1, 2011 — National Public Radio’s Julie Rovner reports that anti-abortion groups such as Personhood USA are pushing to redefine life as beginning at fertilization and interviewed Dan Grossman, Ibis Senior Associate and University of California, San Francisco OBGYN, for the story. Dr. Grossman responded that the medical community defines pregnancy as beginning once implantation of a fertilized egg occurs, rather than at the time of fertilization. The main reasons for this are that only half of fertilized eggs become ongoing pregnancies and, practically, because pregnancy is only detected by hormone changes in urine after implantation occurs.
  
  Dr. Grossman also recognized the implications of efforts to redefine life as beginning at fertilization for women’s health, noting that such efforts could impact women’s contraceptive options by reclassifying some safe and effective birth control methods as abortifacients.
  
  To listen to or to read the full story, click here.

May 2011

• Reproductive health and rights the focus of May Women’s Health Issues supplement
  Special issue showcases the work of social scientists dedicated to abortion research
  
  May 9, 2011— This month’s supplement to Women’s Health Issues (WHI) celebrates the work of Ibis’s Ellertson Fellows, an exciting group of social scientists and public health researchers who study abortion and reproductive health and rights. The fellows were part of an innovative postdoctoral program, the Charlotte Ellertson Social Science Postdoctoral Fellowship in Abortion and Reproductive Health, which supported the development of a new generation of researchers dedicated to high quality research on abortion. From 2003-2010, 14 Ellertson fellows received salary support, mentoring, and communications and advocacy training to develop research projects that would inform abortion and reproductive health policy and further their careers in abortion research. The WHI supplement features 13 original articles, with contributions from every fellow that participated in the program.
  
  Social science research on abortion is critically important to inform and evaluate abortion service-delivery and policy. Findings from US and international research on how policies impact women and families, how and why providers offer services, the quality and acceptability of services, and barriers to access and information show where policies are not meeting women’s needs and how those policies should be changed to enable women and families to live healthy and satisfying sexual and reproductive lives. Because of the US and international political battles and stigma surrounding abortion, high quality research has not received sufficient funding or attention—the Ellertson Fellowship aimed to legitimize abortion as a critical topic for social science researchers and catalyze attention to the issue across social science disciplines.
  
  Kelly Blanchard, President of Ibis, said, “It has been a pleasure to work with such a talented group of committed researchers. Rigorous research on abortion and sexual and reproductive health is critical because these issues are so important to women and families—the research these fellows have done and continue to do will help ensure policies and services are designed in ways that meet women’s needs and improve women’s health. I look forward to all the exciting contributions they will continue to make in their fields.”
  
  The Ellertson Fellowship was named for Ibis's founder, Dr. Charlotte Ellertson, whose own clinical and social science research on abortion, contraception, and HIV-prevention technologies aimed to increase access to products and services that would give women control of their reproductive health and lives. Charlotte played a critical role in the approval of mifepristone for early medication abortion in the US and was a key player in global efforts to improve provider knowledge and women’s access to emergency contraception. Charlotte was passionate about women’s health and rights and used her research training in creative ways to address challenging and controversial topics. She died of breast cancer in 2004.
  
  The fellows represent a cross-section of social science, with doctoral degrees in demography, sociology, anthropology, epidemiology, public health, and psychology. They completed their fellowships at Columbia University, the Guttmacher Institute, Ibis Reproductive Health, Johns Hopkins University, and University of California, San Francisco. Fellows currently work as university faculty, at private research institutions, and as independent researchers. As this volume shows, their work offers critical insights and proposes bold solutions that can help improve reproductive health policies and advance abortion and reproductive health research in years to come.
  
  To read the WHI supplement, click here
  
  

March 2011

• Ibis celebrates one-year anniversary of the Affordable Care Act
  March 23, 2011 — This week marks the one-year anniversary of the passage of the Affordable Care Act, the US health reform law, which promises to have a significant impact on women’s and girls’ access to health care. Ibis is celebrating by blogging about the benefits of the new law on MomsRising.org and RH Reality Check. Check out posts from Ibis staff and our partners:
  • "Increasing access to health insurance for young adults: An unheralded benefit of the ACA," MomsRising
  • "In Massachusetts, health reform is a lifesaver for women," MomsRising
  • "'Making it feasible for people': Young adults on Massachusetts health care reform," MomsRising
  • "Public funding of family planning is essential, even under health reform," RH Reality Check

February 2011

• New research sheds light on the use of over-the-counter birth control pills
  Study of natural experiment along US-Mexico border has implications for a possible future OTC pill
  
  February 22, 2011 — Women who obtain oral contraceptives over the counter in Mexico are likely to stay on the birth control pill longer than those who obtain pills by prescription at US clinics, according to a study by researchers from two University of Texas campuses, Ibis Reproductive Health, and New York University.
  
  The study was led by Joseph Potter, professor in the Sociology Department and Population Research Center at The University of Texas at Austin.
  
  The Border Contraceptive Access Study takes advantage of a natural experiment along the US-Mexico border, where US women have the option of obtaining oral contraceptives over the counter in Mexico, and it provides insight into what might happen if the pill were made available OTC throughout the US. The researchers interviewed more than 1,000 El Paso, Texas oral contraceptive users and followed them over nine months. Half of the women obtained their pills over the counter at pharmacies in Juarez, Mexico, while the other half obtained them from family planning clinics in El Paso. Most women in the study were low-income and uninsured.
  
  According to the findings, women who obtained pills in El Paso clinics were 60% more likely to stop taking their pills during the nine-month study compared to those who purchased their contraceptives without a prescription in Mexico. Women who received fewer than six packs of pills at one time at the clinic were about 80% more likely to discontinue taking the pill compared to over-the-counter users. 
  
  The results suggest that access is a key determinant of contraceptive continuation. “Removing unnecessary barriers to access—such as limits on the number of pill packs dispensed or even possibly the prescription requirement—could have an important impact on reducing unintended pregnancy,” Potter says.
  
  In a related paper from the Border Contraceptive Access Study, the researchers found that women who purchased their pills over the counter in Mexico might not be making the best choice about which kind of birth control is safest for them.
  
  The study, led by Daniel Grossman of Ibis Reproductive Health, found that women who obtained combined oral contraceptives, which contain both synthetic estrogen and progesterone, in Mexico were significantly more likely than US clinic users to have health conditions such as hypertension or smoking over age 34 that may put them at risk while using this type of pill.
  
  While there was no difference in absolute contraindications, relative contraindications were significantly more common among over-the-counter users (13%) compared to clinic users (9%). Although no woman in the study reported a medical complication related to pill use, these contraindications may put women at higher risk of having a heart attack or stroke while using estrogen-containing pills.
  
  The findings highlight the importance of self-screening for contraindications when pills are made available over the counter, said Grossman, who also coordinates a working group of researchers, clinicians, and advocates exploring the feasibility of an OTC switch for pills in the US.
  
  “If combined oral contraceptives are available over the counter, we need to be sure that women have the necessary tools to determine whether they are appropriate for this kind of pill,” Grossman said. “Alternatively, progestin-only pills, which don’t contain estrogen, might be the best option as the first over-the-counter oral contraceptive in the US.  Progestin-only pills are also very effective, but they have many fewer and rarer side effects.”
  
  The Border Contraceptive Access Study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The findings will be published in the March issue of Obstetrics & Gynecology.
  
  Click here to view the full article for the study by Potter et al.
  Click here to view the abstract for the study by Grossman et al.
  Contact us to request the full article by Grossman et al.
  
  For more information, contact: Britt Wahlin, 617-549-2852

January 2011

• In a letter to the Surgeon General, Ibis urged contraception inclusion as part of preventive health care in the US National Prevention Strategy. The letter asserted that access to contraception would help to “reduce unintended pregnancy and improve the lives of women and their families.” Ibis pointed to the large need for contraception in the United States, the United States’ high unintended pregnancy rate, and the aim of the Center for Disease Control to reduce unintended pregnancy, to highlight the need for specific recommendations regarding contraception to be added to the National Prevention and Health Promotion strategy.

December 2010

• We are pleased to announce the launch of My Little Black Book for Sexual Health: A guide for getting the health insurance you need to prevent pregnancy until you’re ready. This youth-friendly, interactive online guide helps young adults navigate their health insurance options and answers questions about finding health plans that work for them and meet their contraceptive needs.
  
  My Little Black Book for Sexual Health was created by the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a statewide project to reduce unplanned pregnancy among young adults in the wake of Massachusetts health care reform. Ibis led the formative research for REaDY, including a systematic review of the young adult-targeted health plans and focus group discussions with young adults across Massachusetts. One of our key findings was that information about health insurance and contraception is often confusing and unclear. Young adults were also unaware of many of the provisions of Massachusetts’ health reform law, though they expressed overwhelming interest in getting more information about contraception and in having resources to help them navigate contraceptive coverage in the new health care environment.
  
  We hope that My Little Black Book for Sexual Health can also serve as a model for advocates and policymakers in other US states as they prepare for national health reform to roll out over the next few years.
  
  Stay tuned for the Spanish-language version of My Little Black Book for Sexual Health, which will be available in January 2011.
  
  
• December 2, 2010 - Barriers to accessing clinical services and a preference for abortion self-induction were among the factors that contributed to women’s decisions to try to induce an abortion on their own, according to “Self-induction of abortion among women in the United States,” by Daniel Grossman et al. published in Reproductive Health Matters this month. The abstract of the article is available here.
  
  Researchers at Ibis Reproductive Health and Gynuity Health Projects surveyed 1,425 women in waiting rooms of clinics serving low-income, predominantly Hispanic/Latina populations in Boston, New York City, San Francisco, and a city in Texas to identify women who had tried to induce their own abortions. Researchers interviewed 30 of the 57 women who reported having attempted self-induction (4.5% of women in the survey who had ever been pregnant). Twenty-five of the 30 women interviewed were living in the continental United States when they tried to self-induce their abortions. 
  
  Women reported using a variety of methods to attempt self-induction, including medications, malta beverage, herbs, physical manipulation, and misoprostol. With the exception of misoprostol, none of the methods women used are known to be effective and some may be unsafe. Of the twenty-three women with confirmed pregnancies, only three reported a successful abortion not requiring clinical care. Only one woman who tried to self-induce while living in the US reported medical complications.
  
  Many of the women interviewed were teenagers at the time they tried to induce their abortions and did not want to tell their parents they were pregnant. Many thought (either correctly or incorrectly) that they needed parental consent to obtain an abortion, and some did not know how to locate an abortion clinic. Financial barriers also prevented some women from seeking clinical services.
  
  Some of the women expressed a preference for self-induction. Some wanted to avoid clinics or felt that self-induction was easier or faster than going to a clinic, and some desired the privacy of their homes and preferred a less medicalized procedure. Others felt self-induction was more “natural” and akin to “bringing down one’s period” rather than an actual abortion.
  
  In a recent national survey of US abortion patients (Jones 2010), 1.2% reported having ever used misoprostol and 1.4% reported having used other methods to try to induce an abortion. However, neither study purports to measure the prevalence of self-induction in the general population, which also might vary in different areas of the country. In some parts of New York City and along the Texas-Mexico border, providers have reported seeing self-induction more frequently, particularly with misoprostol.
  
  “This study provides insight into barriers women continue to face in accessing abortion care as well as their preferences around the type of care they receive,” said principal investigator Dr. Daniel Grossman, a senior associate at Ibis Reproductive Health and practicing obstetrician/gynecologist. “Women—especially young women and immigrants—need better education about state and federal abortion laws and the availability of clinical services. 
  
  “We also need to expand access to medication abortion, which may appeal to women who seek a more natural, private, or less invasive abortion experience.”
  
  For more information or to request a copy of the article, please contact Britt Wahlin at bwahlin@ibisreproductivehealth.org or 617-349-0054.
  
  References:
  Grossman D, Holt K, Peña M, Lara D, Veatch M, Córdova D, Gold M, Winikoff B, Blanchard K. Self-induction of abortion among women in the United States. Reproductive Health Matters 2010;18(36):136–146.
  
  Jones RK. How commonly do US abortion patients report attempts to self-induce? American Journal of Obstetrics & Gynecology 2010 [Epub ahead of print].

   

November 2010

• We are thrilled to share a new collection of resources on medication abortion. Ibis aims to improve access to medication abortion for women around the world through clinical and social science research. We test ways to make protocols and regimens—including both mifepristone and misoprostol and misoprostol-alone options—more user friendly; explore ways to improve access to medication abortion services and service delivery; and examine global policy related to medication abortion. Drawing from a large collection of completed research on medication abortion from a variety of contexts and regions, Ibis developed three briefs: Making protocols and regimens more user friendly, Strategies for improving service delivery and access to services, and Education and training. We hope that you will download and share these materials!

October 2010

• The Department of Health and Human Services recently took public comments on two proposed rules on important facets of the Patient Protection and Affordable Care Act, the health care reform law passed in March 2010. Ibis submitted comments on both the rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services and the rules for Pre-existing Condition Insurance Plans. In our comments on preventive coverage, we use findings from our studies on access to contraception for low-income women and young adults after health care reform in Massachusetts to support a recommendation that contraception be included in the preventive health care package. In the comments we submitted on pre-existing conditions, we use findings from our work investigating Medicaid funding for abortions in cases of rape, incest, or life endangerment to support a recommendation that the administration remove the current restriction on abortion coverage in the Pre-existing Conditions Insurance Plans.
  
  
• The Oral Contraceptives (OCs) Over-the-Counter (OTC) Working Group has launched its website: www.OCsOTC.org. The OCs OTC Working Group is a coalition of reproductive health rights and justice organizations, nonprofit research and advocacy groups, university-based researchers, and prominent clinicians who share a commitment to providing all women of reproductive age easier access to safe, effective, acceptable, and affordable contraceptives. The working group, which is coordinated by Ibis Reproductive Health, was established in 2004 to explore the potential of over-the-counter access to oral contraceptives to reduce disparities in reproductive health care access and outcomes, and to increase opportunities for women to access a safe, effective method of contraception, free of unnecessary control, as part of a healthy sexual and reproductive life. The new website includes the group’s statement of purpose, frequently asked questions about OCs OTC, brief descriptions of past working group meetings, an archive of past updates, and a detailed bibliography, including coverage in the press and in blogs, among other items.

September 2010

• In the September 13, 2010 issue of The Nation, Laura Tillman describes the experience of a woman in Brownsville, Texas, who obtained misoprostol to induce a miscarriage after she discovered an unwanted pregnancy. Misoprostol is one half of the two-drug regimen approved for medication abortion in the United States, and can also be used alone to safely induce an abortion in early pregnancy. Ibis Senior Associate Dan Grossman is quoted in the article about the barriers to abortion access in the United States, like the high cost of health care, which may push some women to seek ways to self-induce an abortion. Ibis began studying women’s experiences with abortion self-induction in the United States in 2007. Through interviews with women in New York, Boston, San Francisco, and a city in Texas, Ibis in collaboration with Gynuity Health Projects assessed women’s access to reproductive health services, their knowledge of the legal status of abortion, their knowledge about ways to self-induce an abortion, and whether or not they themselves have ever tried to induce an abortion on their own. The results of the study are currently under review for publication.
  
  
• In a special contribution to Statesman.com on September 3, 2010, Ibis Senior Associate Dr. Daniel Grossman and colleague Dr. Joseph Potter from the University of Texas lament the limits of the new health care reform law which does not extend coverage, including contraception, to unauthorized or recent immigrants. They write in response to recent press coverage of a report showing a relatively high birth rate among unauthorized immigrants; this trend has been characterized as an effort for “anchor children” who can help their chances of becoming legal residents. Grossman and Potter point out that it is worthwhile to look at research evidence which shows a high proportion of unwanted pregnancies among immigrant populations, and to consider the barriers to access to contraception which contribute to this outcome. Ibis and the University of Texas recently published research in the American Journal of Public Health examining experiences obtaining contraception among women living on the US-Mexico border. The main focus of the research was to compare women who obtain oral contraception at clinics in the US and those who obtain their pills at pharmacies in Mexico. However, a surprising finding from the study was that over half of all women surveyed, and more than 60% of Latina pill users, wanted no more children and would rather be sterilized than take oral contraceptives. Potter and Grossman point out that many women are denied access to this highly effective and cost-effective birth control method because they do not have insurance to cover the procedure. Learn more about this research here.

June 2010

• In the June 22 New York Times, Ibis President Kelly Blanchard makes the case for moving oral contraceptives (OCs) over the counter (OTC). Though there was significant coverage of the 50th anniversary of FDA approval of the pill in May, there was scant discussion of this strategy for addressing some of the challenges facing women accessing birth control in the United States. In the piece, Kelly shows that the pill meets FDA criteria for over-the-counter medicines and shares evidence about women's ability to self-screen for contraindications.
  
  Ibis coordinates the OCs OTC Working Group, a coalition of researchers, clinicians, advocates, and industry representatives who share a commitment to providing all women easier access to safe, effective, acceptable, and affordable contraceptives. We look forward to continuing to stimulate public discussion on this topic and to building consensus around an over-the-counter switch for oral contraceptives at an accessible price. For more information about the Working Group, please email Kate Grindlay at kgrindlay@ibisreproductivehealth.org.
  

May 2010

• In a letter to the editor on May 21, 2010, Ibis Board member Carmen Barroso praised columnist Nicholas Kristof for his coverage of the global unmet need for contraception. Barroso, director of International Planned Parenthood Federation/Western Hemisphere Region, underscores that attention to this topic is crucial. She points out that the Millennium Development Goal (MDG) of universal access to reproductive health “is the most off track of all the goals,” though achieving this goal is crucial for achieving the other MDGs.
  
  
• May 5, 2010 - New research from Ibis Reproductive Health shows that insurance coverage of contraception is a significant factor in young women's decisions about contraceptive use and method selection in Massachusetts.
  
  A report released today summarizes the key findings from a series of focus group discussions held with diverse young adults, ages 18 to 26, from across the Commonwealth. In addition to being unclear about their own health insurance coverage, participants demonstrated a lack of knowledge about the various provisions of the new health care reform law, which took effect in 2007, including those directly targeting young adults. Many study participants were unaware of provisions that would provide temporary coverage during transitions such as graduating from college or starting a new job. Many participants also lacked knowledge about the full range of contraceptive options. All of these factors affect young adults' access to and consistent use of effective methods of contraception. "For many young adults, accessing health care is synonymous with accessing contraceptive services," said lead author Dr. Danielle Bessett. "Our participants expressed overwhelming interest in getting more information about contraception and in having resources to help them navigate contraceptive coverage in the wake of health care reform."
  
  The study also found that several sub-populations of young adults face significant barriers to accessing contraceptive care, including enrollees in plans without a prescription drug benefit, university students, especially those at religiously-affiliated institutions, and temporarily uninsured young adults. "Health care reform in the Commonwealth has undoubtedly provided young adults with important new options for accessing reproductive health services. However, this study highlights a number of the gaps in the current system and suggests systems-level changes that could improve access to affordable care," said the study's principal investigator Dr. Angel Foster. To read the findings and the recommendations for future action, please download the report and executive summary.
  
  The research was undertaken as part of the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a statewide project to reduce unplanned pregnancy among young adults in the wake of Massachusetts health care reform. REaDY is led by an Executive Committee of multiple organizations and agencies within the Commonwealth. Ibis is leading the formative research component, and the statewide, multi-agency taskforce is chaired by the Massachusetts Department of Public Health Family Planning Program and coordinated by the Pro-Choice Massachusetts Foundation. Other Executive Committee members include the Massachusetts Family Planning Association, youth development specialist TiElla Grimes, and the Boston Public Health Commission.
  
  For more information, please contact Britt Wahlin at bwahlin@ibisreproductivehealth.org or 617-349-0054. Visit our website to learn more about the REaDY Initiative and Ibis's other work related to Massachusetts health care reform.

April 2010

• At the 2010 National Abortion Federation Annual Meeting, Ibis Senior Associate Dr. Daniel Grossman was awarded the Social Science Scientific Paper Award for Ibis’s research evaluating the use of telemedicine to improve access to abortion in rural settings. In approximately 35 states in the US, physician-only laws limit the provision of abortion—including medication abortion—to doctors. Until these laws can be changed, we need innovative ways to extend the reach of the limited number of physician providers in these states.
  
  Technology might provide an intriguing solution. Planned Parenthood of the Heartland in Iowa developed an innovative service delivery model through which medication abortion is provided using telemedicine, and women undergo a consultation and evaluation with a physician via video teleconference. Ibis worked with Planned Parenthood of the Heartland and the Abortion Access Project to evaluate the clinical outcomes and acceptability of the telemedicine model compared to standard, face-to-face provision. The telemedicine provision model was found to be at least as safe, effective, and acceptable as the standard model. We plan to publish these results in the near future and look forward to using our findings to expand the telemedicine model to clinic systems in different areas of the country.
  
  
• April 15, 2010 -- American women who live along the US-Mexico border frequently buy over-the-counter oral contraceptives from Mexican pharmacies because they don't need a prescription and can send a friend to pick up the pills, according to a study by researchers from two University of Texas campuses and Ibis Reproductive Health.
  
  The research, conducted in the El Paso-Juarez area, suggests there is demand in the United States for over-the-counter birth control pills and that many US women would buy such contraception without a doctor's prescription if given the option. The findings are being published this week in the American Journal of Public Health.
  
  "The fact that many women in El Paso make use of the cross-border option suggests a substantial latent demand for an over-the-counter option at pharmacies in the United States," says lead author Joseph E. Potter, a professor in the Sociology Department and Population Research Center at The University of Texas at Austin.
  
  "Since crossing the border can be time-consuming for many, a domestic over-the-counter option would provide even more convenience than the cross-border option that's available in El Paso."
  
  The study's other authors are Kari White and Kristine Hopkins of The University of Texas at Austin, Jon Amastae of the University of Texas at El Paso, and Daniel Grossman of Ibis Reproductive Health.
  
  Women are now required to get a prescription to obtain oral contraceptives in the US. But the high prevalence of unwanted pregnancy and mounting evidence about the safety of such pills have led some to call for an over-the-counter option.
  
  Grossman, who also coordinates a group of researchers, clinicians, and advocates exploring the feasibility of an over-the-counter option for pills in the US, says, "This study gives us a better idea of who might take advantage of the over-the-counter option if it were available in the US, and it suggests that it would appeal to a broad range of women."
  
  As part of the study, researchers interviewed more than 1,000 El Paso women, about half of whom obtained their birth control pills across the border at Mexican pharmacies and half of whom went to US clinics to get their pills.
  
  Older women and those who were born and educated in Mexico were more likely to buy their pills in Mexican pharmacies. Women who received public assistance from such federal programs as Women, Infants, and Children were more likely to go to the US clinics.
  
  Among both groups, most of the women said they believed the facility where they obtained the pills was cheaper and more convenient than the options on the other side of the border.
  
  About 90 percent of the women who obtained oral contraceptives on the US side say they trusted their clinic to give them good information (versus 46 percent of Mexican pharmacy consumers) and that they liked the other health services provided there.
  
  Conversely, about 90 percent of the women who bought pills from the Mexican pharmacies said they wanted to bypass a doctor's prescription and be able to send family or friends to pick up the pills.
  
  "Making oral contraceptives available over the counter in the US would add another option for women who find the clinic inconvenient or inaccessible. Our research shows that some women highly value the services they receive at clinics, and it's important that they continue to have access to those services even if the pill goes over the counter," says Grossman.
  
  This publication is featured by the American Journal of Public Health in their "First Look" at the June issue. The attention to this important subject is all the more thrilling because Ibis's founder, Charlotte Ellertson, was involved in the initial development of the project. We are excited to see her idea come to fruition and to have this research influence the public conversation about increasing access to contraception in the US.
  
  For more information about this study or Ibis's work on moving oral contraceptives over the counter, please contact Britt Wahlin at bwahlin@ibisreproductiveheath.org
  or 617-349-0054.
  
  
• April 7, 2010 -- The Medicaid system is not meeting the needs of women seeking abortion services, even in cases that qualify for federal funding under the current Hyde Amendment restrictions. This is the main finding from the article “Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape, Incest and Life Endangerment,” by Deborah Kacanek, Amanda Dennis, Kate Miller, and Kelly Blanchard of Ibis Reproductive Health. The article is currently available online and will appear in the June 2010 issue of Perspectives on Sexual and Reproductive Health.
  
  The Hyde Amendment, first enacted in 1976, bans federal funding for abortions in the United States except in cases where the pregnancy resulted from rape or incest or endangers the life of the woman. Ibis Reproductive Health interviewed abortion providers about their experiences working with Medicaid to obtain coverage for abortions in these limited cases in order to examine the impact of restrictive funding polices on low-income women. Researchers conducted in-depth interviews with representatives of 25 abortion providers in six states that limit Medicaid funding to the restrictions imposed by the Hyde Amendment (FL, ID, KS, KY, PA, WY). They found that of the 245 reported abortions that should have qualified for Medicaid reimbursement in the year prior to their interview, only 102—less than half—were actually covered—and 97% of those were in one state.
  
  Respondents reported that administrative burdens, including excessive staff time needed to manage claims, cumbersome claims procedures, and ill-informed Medicaid staff, hampered their efforts to seek reimbursement. Bureaucratic Medicaid policies and procedures led to delays for women in obtaining abortions and also meant women had to delay treatment for life-threatening conditions such as cancer and HIV. In addition, some women were prevented from obtaining abortions. Because of the excessive burden of applying for Medicaid reimbursement in these limited cases, many providers said they have “given up” on working with Medicaid.
  
  Under the new US health care reform law, even more women—including those newly eligible for Medicaid, as well as those who purchase health plans with federal subsidies—may be denied access to abortion care. “The Medicaid system is broken. If women who fall under the ‘exceptional’ cases cannot get Medicaid to pay for their abortions now, the problem will only get worse as more women are affected by restrictions in the new health care system,” said Kelly Blanchard, president of Ibis Reproductive Health.
  
  When Medicaid funding was not available, even in cases that by law should have been covered, women often had to put off paying their bills, sell their belongings, or borrow money from friends and relatives. Providers sometimes offered discounts to women or absorbed the full or partial costs of abortions. Both women and providers turned to abortion funds, local nonprofits which raise money from community members to help individual women cover the costs associated with an abortion. Providers said the abortion funds are a “lifesaver” for many women in need. 
  
  “In order to ensure that all women, regardless of income or insurance status, have equitable and timely access to abortion services, we must overturn the Hyde Amendment. But in the meantime, steps must be taken to make sure Medicaid pays for abortions in cases that should be covered under current law,” said Blanchard.
  
  Ibis Reproductive Health has developed a body of work that examines the impact of restrictive federal funding policies on US women. Our interviews with abortion providers in other states corroborate our finding that women are mostly unable to access federal Medicaid funding for abortion in qualifying cases. We are currently conducting research in states that use their own funds to pay for abortions for women covered by Medicaid and are also examining barriers to abortion and reproductive health care access for women in the military.
  
  This article, which will be published in the June issue of Perspectives, is now available to subscribers through the Early View feature. For more information about Ibis’s body of work on abortion funding restrictions, please visit our project description.
  
  For more information about this study or Ibis's work on abortion funding restrictions, please contact Britt Wahlin at bwahlin@ibisreproductiveheath.org or 617-349-0054.

March 2010

• On March 17, 2010, the Cochrane Review published an updated review which concluded that providing emergency contraception (EC) to women in advance of intercourse does not affect the rate of pregnancy compared to women who do not have EC on hand. The review took into account evidence from three new studies since the original review was published in 2007. Looking at 11 total publications on advance provision of EC, the review finds that advance provision has not reduced unintended pregnancy on a population level. However, the review also found that advance provision of EC did not result in an increase in risky behaviors like unprotected sex. The review underscores that all women should have timely access to emergency contraception, as EC is a safe and effective method of pregnancy prevention for individual women who use it when needed.
  
  The release of the review coincided with Back Up Your Birth Control Day on March 24; this advocacy campaign is aimed at increasing access to EC in the US. Advocates have been focusing on pushing the US Food and Drug Administration (FDA) to revise age restrictions on over-the-counter (OTC) access to EC, as these restrictions are not supported by evidence. The FDA currently requires young women under the age of 17 to obtain a prescription before obtaining EC in a pharmacy, though the panel which reviewed the OTC application in 2006 recommended approval for all ages and a federal court ordered the FDA a year ago to reconsider the age restrictions.
  
  To read more discussion of the review, see coverage from news outlets and blogs such as Time Magazine, Salon Broadsheet, the LA Times, and BBC News. Ibis President Kelly Blanchard is a co-author of the review.

January 2010

• In a recent post on the blog for Health Affairs, a health policy journal, Ibis Senior Associate Dan Grossman and colleagues from UCSF and Princeton examine data about out-of-pocket health expenses by the uninsured to demonstrate the burden of cost that could result if proposed restrictions to abortion coverage are made into law through health care reform in the US. The data show that out-of-pocket costs are higher for young, uninsured women than for young, uninsured men. The average cost for first trimester abortion is about double, and second trimester abortion costs almost four times, the current average out-of-pocket expenditures for young, uninsured individuals. Excluding abortion coverage from health care reform not only places an unfair financial load on women, it betrays the goals of health care reform to equalize access and reduce barriers to care.