> > 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