In This Issue:

Ibis Staff Receive Reproductive Health Awards

Health Care Reform in Massachusetts and Reproductive Health Care

Staff Updates

Upcoming Events

Dear Friend,

I am thrilled to report that over the past few months several Ibis staff have received awards for their contributions to the reproductive health field. Angel Foster, Daniel Grossman, and I have been recognized by our colleagues, and we share more information about each award in the first article below. We are honored to receive this recognition and are grateful to the Ibis staff, as well as to our board, our donors, and our collaborators in the research, advocacy, and provider communities, who have helped Ibis grow a body of cutting-edge, policy-relevant research over the past seven years. It is a privilege to work on issues that are so essential to improving women’s lives, and we are delighted that our work is making a difference.

I’m also pleased to share with you research we recently carried out in Massachusetts, where our Cambridge office is located. Our research investigated the effect of Massachusetts’ groundbreaking health care reform on access to contraception and other sexual and reproductive health services. With health care reform being hotly debated in the US, we think our research findings and recommendations provide many lessons for national health care reform and for other US states considering overhauling their own health systems.

Thank you for your support and collaboration.

Kelly Blanchard, President

Ibis Staff Receive Reproductive Health Awards

Ibis is pleased to share that two more Ibis staff have been recognized for their exemplary work in the field of reproductive health. Senior Associate Dr. Angel Foster was given the American Public Health Association Population, Reproductive and Sexual Health Section’s Outstanding Young Professional Award at the section meeting on November 9, 2009, for being “an influential advocate and researcher for women's reproductive health,” especially for her work in underserved regions like the Middle East and North Africa. In addition, Senior Associate Dr. Daniel Grossman was named a 2009 Visionary Partner by the Pacific Institute for Women’s Health. This new award “is given to individuals who work across the globe to support women’s access to the full range of reproductive health options, including the latest reproductive health technologies.” Please join us in congratulating Drs. Foster and Grossman!

In September Ibis President Kelly Blanchard was named the recipient of the 2009 Darroch Award for Excellence in Sexual and Reproductive Health Research, sponsored by the Guttmacher Institute. This award is given every two years to recognize a leader who has contributed outstanding research that has practical implications for public policy and sexual and reproductive health programs.

We are proud of these accomplishments by our staff, and are honored to receive this recognition from our respected reproductive health colleagues.

(Photo: From left to right, Angel Foster, Kelly Blanchard, and Dan Grossman)

Health Care Reform in Massachusetts and Reproductive Health Care

In 2006, the Commonwealth of Massachusetts passed legislation aimed at improving access to affordable, high-quality health care by mandating that all residents have health insurance by July 2007. Massachusetts’ effort to achieve universal health care offers a unique opportunity to examine how health care reform affects women’s access to contraception and other reproductive health services. Ibis has taken on two such projects.

REaDY (Reproductive Empowerment and Decision Making for Young Adults): An Initiative to Prevent Unplanned Pregnancy and Promote Sexual Health
In July, Ibis released an assessment of the contraceptive coverage of young adult-targeted health insurance plans in Massachusetts. This was the first of three research components Ibis has undertaken as part of the REaDY Initiative, a coalition of Massachusetts health service providers, advocates, and researchers working to reduce unplanned pregnancy among young adults, which as a group face high rates of unintended pregnancy.  

Young adults are a population that has historically been disproportionately uninsured and thus was specifically targeted through Massachusetts health care reform. In order to provide young adults with affordable insurance options, the Commonwealth developed Young Adult Plans (YAPs) for young women and men aged 18 to 26 who do not have access to employer-sponsored coverage. The YAPs were modeled after the Student Health Program (SHP), which was enacted in Massachusetts in 1988 and mandates that students enrolled at least 75 percent time in institutes of higher learning participate in a qualified student health insurance program or provide proof of comparable coverage.

Ibis conducted a rigorous, systematic review of 19 YAPs and SHPs to determine the plans’ coverage of contraceptive services and counseling and other reproductive health services. The reviewers gathered publicly available information on the types of contraceptive and other reproductive health services covered, the costs associated, the facilities providing services, and the comprehensiveness and accessibility of information provided by the plans.

The results of this study raise concerns that young adult-targeted health plans may not provide the full range of contraceptive services. Specifically, YAPs that do not offer a prescription drug benefit fail to provide coverage for prescription contraceptive methods, which raises important questions about gender (in)equity in health care financing. Information about contraceptive and other reproductive health coverage available on plan websites is limited and difficult to find. Eligibility requirements for YAPs as well as government-subsidized plans for low-income residents make it hard for a young adult to choose a different plan if the reproductive health or contraceptive services they need are not covered. Our findings also indicate that young adults may be unaware of the limitations in their plans and may lack information about where affordable services are offered.

The recommendations from the research include creating information resources to help young adults understand and navigate coverage in the YAPs; requiring health plans to disclose limitations and exclusions, including restrictions on contraceptive coverage; and developing mechanisms for providing contraceptive services to underinsured young adults.

Other research components of the REaDY Initiative include focus group discussions with young adults across the Commonwealth and interviews with clinicians who care for young adults. Results from these studies will be available toward the end of 2009. Research findings will inform actions undertaken by REaDY’s statewide, multi-agency taskforce, chaired by the Massachusetts Department of Public Health Family Planning Program and coordinated by the Pro-Choice Massachusetts Foundation, to make health care providers more responsive to young adults’ reproductive and sexual health needs.

(The Boston Globe printed a letter to the editor from Ibis staff on November 14, 2009, which cited this research and urged the Commonwealth to take steps to improve young adults’ access to contraceptive information and services.)

Low-Income Women’s Contraceptive Access after Massachusetts Health Care Reform
Ibis and the Massachusetts Department of Public Health (MDPH) Family Planning Program collaborated on a study to assess the effects of health care reform in Massachusetts on low-income women’s access to contraception. The research project included a review of the government-subsidized insurance plans available to low-income Massachusetts residents, surveys and in-depth interviews with family planning providers around the Commonwealth, and English- and Spanish-language focus group discussions with low-income women.

Since health care reform, low-income Massachusetts residents who are not Medicaid- or Medicare-eligible or do not have employer-sponsored insurance are able to enroll in government-subsidized private insurance plans called Commonwealth Care. Low-income women without health insurance have had longstanding access to contraception and other reproductive health services on a sliding-scale basis through freestanding family planning clinics and community health centers funded by MDPH, the federal Title X program, Medicaid (MassHealth), and other funding streams, and these services continue to be available.

Many women and providers who participated in the study reported that reform has increased access to both health insurance and services. Women in the study identified other positive effects, such as the ability to seek preventive care and reduced stigma from having insurance. However, some new challenges have resulted; both women and providers have difficulties finding information about insurance coverage of services, women struggle to maintain and prove eligibility for subsidized insurance plans, and family planning providers have taken on increased administrative and fiscal responsibilities.

“Women talk about the emotional benefits of knowing they have insurance, and how that might encourage use of health services,” says Kelly Blanchard, president of Ibis. “At the same time health care reform has spread some of the challenges inherent in the private insurance model, which appears to have created barriers to access to contraception for some women.”

Though most women who participated in the study reported that they continue to have relatively easy access to contraceptive services, it appears that some new barriers to accessing contraception have arisen from reform. Limits to the amount of contraception dispensed at once, high copays, inconvenient pharmacy locations, pharmacists’ lack of knowledge about what prescriptions are covered by the new subsidized plans, and even women’s unfamiliarity with how to use prescriptions were named as new challenges to contraceptive access for previously uninsured women accustomed to obtaining care from clinics and community health centers.

In addition, our research found that health care reform has left out some populations of women. For immigrants, young women, those with unstable employment or income, and those experiencing common life changes such as moving or pregnancy, access to health care has not improved or has gotten worse since health care reform was enacted.

One of the study’s key findings is that family planning providers are helping to mitigate some of the challenges with implementing health care reform. They have provided specific outreach to and services for hard-to-reach and underserved populations and have also helped women navigate and enroll in the new insurance plans.

For more detailed information about the findings and the recommendations of the project team, read the executive summary and the full report, released in September.

Staff Updates

We are happy to welcome two staff members to Ibis! Carol Powers joined the Cambridge office in March as a bookkeeper and office assistant. Carol has worked in financial and administrative support positions, and has also taught English in Finland, Costa Rica, and Hungary. She graduated from Vassar College, and continues as a part-time student. Kate Grindlay is our new Project Manager in Oakland, CA. Kate recently received a Master of Science degree in Global Health and Population from Harvard University. Prior to joining Ibis, she worked at the University of California, San Francisco’s Women’s Global Health Imperative as a Site Leader and Data Manager Assistant on the MIRA diaphragm trial. We are thrilled to be working with these two new talented colleagues.

We send warm wishes to two research assistants from the Cambridge office. Denisse Cordova left us in July to pursue a law degree at the University of Pennsylvania. Denisse was a valued member of the project teams for our research on self-induced abortion, US abortion restrictions, and low-income women’s access to contraception after Massachusetts health care reform. Madina Agenor, a doctoral student at the Harvard School of Public Health, has played a crucial role in the REaDY Initiative, as lead author of the report on contraceptive coverage in young adult-targeted health plans and as a facilitator of focus group discussions with young adults. We will miss Denisse and Madina and wish them the best of luck in their studies.

We are lucky to continue to have talented and passionate interns working with us at Ibis. Danielle Murphy worked with us from June to August and contributed to a number of projects in our portfolio. Our current interns include Madeline Taskier, Tufts University, and Adrianne Nickerson, Harvard School of Public Health, who are assisting with the third phase of our research on US abortion providers’ experiences in accessing Medicaid funding for abortion, and Joanna Prager, who is contributing to Ibis’s REaDY Initiative research and to our research on US abortion providers’ experiences in accessing Medicaid funding for abortion. We send a big thank you to all of our interns for their hard work!

Upcoming Events

We will be hosting a reception for friends, colleagues, and supporters at our office in Oakland, California, on December 9. Please email jstone@ibisreproductivehealth.org if you would like more information or to RSVP.