> Poor Access to Abortion Endangers Women's Health
>
> Run Date: 09/18/00
>
> By Melinda Voss
> WEnews contributing editor
>
> States can improve women's
> health by ensuring access to abortion services, but most states, and the
> nation as a whole, have failed to do so, according to a comprehensive
> state-by-state study. It grades 48 states "F." A newly developed Report
> Card on women's health gave 48 states an "F" because, it says, the lack
> of health care practitioners who provide abortion services in those
> states endangers women's health and lives.
>
> Only Hawaii, Massachusetts and the District of Columbia received a
> passing grade. The nation, as a whole, flunked because almost one-third
> of all women live in a county with no abortion provider.
>
> Released in August, the Report Card was created by the National Women's
> Law Center, the University of Pennsylvania School of Medicine's FOCUS on
> Health & Leadership for Women and The Lewin Group, a health policy
> consulting firm.
>
> Abortion services are a critical indicator of women's health, said
> Sharon Levin, senior counsel for the National Women's Law Center. "The
> reality is that there are times when an abortion is necessary to protect
> the health and life of a woman, and if there is no abortion provider,
> that can and does put her health or her life at risk."
>
> States were graded on the availability of abortion services by comparing
> the percentage of women living in counties without abortion providers to
> the percentage of women living in counties without an office-based
> obstetrician-gynecologist. The authors said abortion services should be
> as available as services for obstetrics and gynecology. Each of the 48
> states that failed had at least 10 percent more women without access to
> an abortion provider in their county than the percentage of those
> without an office-based obstetrician-gynecologist.
>
> Called "Making the Grade on Women's Health: A National and
> State-by-State Report Card," the report used various indicators besides
> abortion services to measure access to health care for women. These
> measures included family planning services, prenatal care, maternity
> care in hospitals and services for victims of domestic violence and
> sexual assault.
>
> Far too many women have no health insurance
>
> In addition, the picture of women's access to health care was bleak.
> Fourteen percent of American women have no health insurance, the report
> showed.
>
> The goal, as defined by the federal government's Healthy People 2010
> project, is for 100 percent coverage.
>
> But no state has met this goal, the Report Card found. And, only eight
> states--Connecticut, Delaware, Hawaii, Massachusetts, Minnesota,
> Nebraska, Rhode Island and Wisconsin--have come within 10 percent of
> that benchmark.
>
> As a result, those eight states received a "U" for unsatisfactory. The
> remaining 42 states and the District of Columbia received an "F" because
> they missed that benchmark by more than 10 percent. The nation as a
> whole also received an "F."
>
> "Access to health care services is an area where almost all of the
> states did badly and the nation as a whole did badly," said Levin.
>
> "We have a lot of work to do here to make sure women have health
> insurance. Even those women who are insured often do not have
> comprehensive insurance that covers all their needs."
>
> Access to prenatal care still not widespread
>
> The Report Card also looked at the availability of prenatal care because
> it is often seen as an indicator of whether women have access to general
> health care services. Prenatal care is also important because women who
> have prenatal care in the first trimester of pregnancy tend to stay
> healthier and have healthier babies, the authors noted.
>
> But no state met the federal government's Healthy People 2000 goal of
> providing first-trimester care to at least 90 percent of all pregnant
> women, the Report Card found. Thirty-six states, however, were within 10
> percent of the benchmark, thus earning a "U" for unsatisfactory. The
> other 14 states and the District of Columbia missed the mark by more
> than 10 percent, so they received an "F." The nation received a "U."
>
> Two simple options for wider prenatal care
>
> To offer prenatal care to more women, states have two simple options,
> said Lewin. States can extend Medicaid benefits to pregnant women who
> earn up to 200 percent of the federal poverty level and they can adopt a
> "presumptive eligibility" rule, which would allow pregnant women to
> receive prenatal care earlier in their pregnancies but before their
> applications for Medicaid have been processed.
>
> On these two policies, the states have a mixed record. Ten states have
> raised the Medicaid eligibility criteria to 200 percent of poverty.
> Twenty-seven states and the District of Columbia have raised the
> eligibility level between 133 and 185 percent of poverty.
>
> "The remaining 13 states are doing the bare minimum they need to do to
> participate in the Medicaid program," Levin said. The income ceiling for
> Medicaid eligibility in those states is 133 percent of this year's
> federal poverty level, which is $14,150 for a family of three in the 48
> contiguous states and the District of Columbia. Thus, 133 percent of
> that is $16,031.
>
> As for presumptive eligibility, 27 states and the District of Columbia
> have adopted it while 23 have not done so, the Report Card found.
>
> Family planning services also found wanting
>
> In analyzing access to family planning services, the Report Card found
> that only 11 states have required private insurers who pay for
> prescription drugs to cover the costs of all five federally approved
> prescription drugs and devices.
>
> Six other states--Colorado, Idaho, Kentucky, Minnesota, New Jersey and
> Texas--require private insurers to provide limited coverage. The
> remaining 33 states and the District of Columbia have no laws requiring
> contraceptive coverage.
>
> The availability of family planning services was another measure of
> general access. States can expand family planning services to more
> low-income women by securing a federal Medicaid waiver to broaden the
> eligibility requirements. Fifteen states have applied for such waivers.
> These expansion efforts have greatly increased the number of low-income
> women served by Medicaid family planning programs, the authors said. The
> other 35 states and the District of Columbia have not applied for the
> waivers.
>
> More services needed for women subjected to violence
>
> Recognizing that violence against women presents a serious health
> problem, some states have attempted to improve access to health care for
> these women by:
>
> Requiring health care protocols, training and screening for domestic
> violence; Prohibiting insurance discrimination against domestic violence
> victims; and Requiring health care workers to follow protocols for
> sexual assault victims.
>
> California is the only state to have all three policies, and only three
> states--Alaska, New York and Pennsylvania--have adopted both domestic
> violence policies and weaker versions of the sexual assault policy. The
> Report Card found that 34 states have had minimal policies. The other 12
> states and the District of Columbia have had no such policies that
> include collecting and preserving evidence for trial and referring women
> to counselor.
>
> Melinda Voss holds a master's degree in public health. A former reporter
> for The Des Moines Register, she now freelances and teaches journalism
> at the University of Minnesota.
>
> To read the whole Report Card, including the state-by-state breakdown,
> visit: http://www.nwlc.org/health.cfm?section=health
>
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