Transcript On a Mission to Meet our Reproductive and Sexual Heath

Sexual and Reproductive Health Issues for
Underserved Women
Lourdes A. Rivera, JD
Managing Attorney
National Health Law
Program
May 25, 2006
Reproductive Health Status of Women of
Color
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African American and Latina Women highest rates of reported
new AIDS cases (48.2/100,000, 11.1/100,000, respectively) in
2004.
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Rate of 6.4 for NA/AN; 1.6 for API
In 2000, teen pregnancy rate: African-Americans -- 153/1,000
teens; 138/1,000 for Latinas; 55/1,000 for Whites. All declining.
More than 1/3 of US women need publicly-supported
contraceptive services and supplies because income is below
250% federal poverty level
Cervical cancer disproportionately affects Latinas, African
American and Korean women in Los Angeles County.
Sources: The Alan Guttmacher Institute/LAC DHS
Reproductive Health: Abortion
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Unintended pregnancy: 98.4/1,000 African-American women
ages 15-44; 69.4/1,000 for Latina; 35.5/1,000 for Whites
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Poor women 4x’s as likely to experience unplanned pregnancy
as higher income woman
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In 2000, 21/1,000 women ages 15-44 had abortions
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49/1,000 African American; 33/1,000 Latina; 13/1,000 White
Rate of abortion increased for women with family income below
200% poverty and women on Medicaid between 1994 – 2000
Source: The Alan Guttmacher Institute
Barriers To Comprehensive
Reproductive Health
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Cost/affordability of health services
Immigration status
Lack of language and cultural accessibility
Lack of comprehensive information and sex education
Breaches of confidentiality
Geographic access/lack of transportation/lack of childcare
Discrimination and lack of access for LGBTQ
Social beliefs & gender roles within communities
Ideological restrictions of health entities and provider refusals
Dissatisfaction with doctor/health care visits
Low education levels/low health literacy
Barrier to Reproductive Health: Lack
Of Health Coverage
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Among women, Latinas are at highest risk for being
uninsured with almost 40% lacking coverage in
2004.
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Latinas: 38% uninsured
African American: 17% uninsured
White: 13% uninsured
Latinas least likely to have regular doctor or to have
had an Ob-Gyn visit in past year; 1 in 3 report
delaying or going without care in past due to cost
Source: The Henry J. Kaiser Family Foundation
Health Insurance Coverage of
Women, by Race/Ethnicity, 2004
Source: The Henry J. Kaiser Family Foundation
70%
70%
59%
60%
50%
38%
40%
Uninsured
Other Coverage
30%
20%
39%
Medicaid
13%
Individually Purcahsed
17%
Employer-Based Coverage
10%
0%
White
African American
Latina
Medicaid’s Role in Reproductive Health
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Coverage to over 7 million women of reproductive age (15-44)
(11.5% of all women in that age & 36.6% with incomes below
poverty line) – prevention, screening and treatment services
Nearly 2/3 of spending on publicly financed family planning
Over 1/3 of all births in the U.S.
All 50 States and the District of Columbia -- breast and cervical
cancer treatment for women otherwise not be eligible for
Medicaid.
Single largest public funding source for HIV/AIDS care in the
U.S.
Sources: Kaiser Family Foundation & Alan Guttmacher Institute/Smith & Moody, Health
Management Assoc./Centers for Medicare and Medicaid Services.
Medicaid Under Attack
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Cuts to Medicaid - Deficit Reduction Act
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Cut $6.9 B over 2006-2010; $28.3 B over 20062015
Higher premiums and co-pays
Family planning no longer mandated benefit
Show birth certificate/passport to apply if citizen
Administration’s proposed FY 2007 Budget
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Federal Medicaid funding cuts equal to $14 billion
over the next five years and $35.5 billion over ten
Health Coverage for Immigrants
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Personal Responsibility and Work Opportunity Reconciliation
Act (PRWORA) – a.k.a “Welfare Reform”
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Concerns about “public charge”
Only Emergency Medicaid for unqualified immigrants
Some states provide Medicaid prenatal care for immigrants,
regardless of immigration status
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Five-year ban for new, otherwise qualified immigrants
Affidavits of support by sponsors
SCHIP coverage of “unborn”
Otherwise county, charity services, community clinics
What will happen with immigration bill and Inhofe
amendment?
Reproductive Health Policies, Politics
and Issues
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Parental Involvement Laws
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Provider/institutional refusals for contraception
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34 states with parental involvement laws (21 require
consent)
“Teen Endangerment Act” (H.R. 748)
Emergency contraception and oral contraception
Politics of the FDA
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EC access over-the-counter
HPV immunization – FDA and CDC’s Advisory Committee
on Immunization Practices
Reproductive Health Policies, Politics
and Issues
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Rights of “Unborn”
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Unborn Victims of Violence Act -- first law to
recognize zygote as separate victim of crime,
instead of protecting pregnant women from
violence
SCHIP Coverage of Fetuses as “qualified
children”
Abstinence-only education
Reproductive Health Policies, Politics and
Issues: Attacks on Abortion Access
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Federal funding restrictions on abortion
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Hyde Amendment on Appropriations– Since 1976
Abortion ban – “Partial-Birth Abortion” ban – SCT to
Review
Weldon Amendment – Labor-HHS- Education
Appropriations
Criminalization of assisting minors – “Teen
Endangerment Act”/”Child Custody Protection Act”
States move to pass bans – e.g., S.D.
As said by Law Prof. Dorothy
Roberts….
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“Reproduction is not just a matter of
individual choice. Reproductive health policy
affects the status of entire groups. It reflects
which people are valued in our society; who
is deemed worthy to bear children and
capable of making decisions for themselves.
Reproductive decisions are made within a
social context, including inequalities of
wealth and power.”
A human rights view of Reproductive
Health
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International Conference on Population and
Development (Cairo, 1994) & International
Conference on Women (Beijing, 1995).
A state of complete physical, mental and social wellbeing, and not merely the absence of disease or
infirmity, in all matters related to the reproductive
system and to its functions and processes.
Implies that people are able to have a satisfying and
safe sex life; capability to reproduce and freedom to
decide if, when and how often to do so.
Reproductive Health (cont.)
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Right to:
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Be informed
Have access to safe, effective, affordable and
acceptable methods of family planning of their
choice
Have access to other methods of regulation of
fertility which are not against the law
Have access to appropriate health care services
that will enable women to go safely through
pregnancy and childbirth and provide couples
with the best chance if having a healthy infant.
Sexual Health
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Ability to Enjoy Mutually Fulfilling Sexual
Relationships
Freedom from Sexual Abuse, Coercion, or
Harassment
Safety from STDs/STIs
Success in Achieving or in Preventing
Pregnancy
Health System Obligations
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Respect
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Refrain from interfering directly or indirectly with
the enjoyment of the right to health
Protect
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Prevent third parties from interfering with the
freedom of people to enjoy the right to health
Health System Obligations (cont.)
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Fulfill
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Ensure that people have access to a system of heath care
that provides equal opportunity for everyone [CESCR
General Comment on Health]:
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Availability – functioning public health and health care
facilities, goods and services, and essential drugs are
available in sufficient quantity.
Accessibility – non-discrimination; physical accessibility;
affordability; information accessibility
Acceptability – ethically and culturally appropriate; sensitive
to gender and life-cycle requirements; respect confidentiality;
improve heath status.
Quality – scientifically and medically appropriate and of good
quality.
Women of Color: A Vision of
Reproductive Justice for All
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The economic, social, political power and resources to make
healthy decisions about our bodies, sexuality and reproduction
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Addresses reproductive oppression -- control and exploitation
of women and girls through our bodies, sexuality and
reproduction by families, communities, institutions and society
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Fights equally for the right to have – and not to have – a child
Sources: Asian Communities for Reproductive Justice & SisterSong
Resources
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Source: Rebecca J. Cook, et. al., Reproductive Health and
Human Rights (Clarendon Press 2003).
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Source: Asian Communities for Reproductive Justice, A
New Vision for Advancing our Movement for Reproductive
Health, Reproductive Rights, and Reproductive Justice
(2005), www.reproductivejustice.org.
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Jael Silliman, et al., Undivided Rights: Women of Color
Organize for Reproductive Justice (South End Press 2004).
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Dorothy Roberts, Killing the Black Body: Race Reproduction
and the Meaning of Liberty (Vintage Books 1999).
Resources
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Collective Voices (Sister Song Women of Color
Reproductive Health and Sexual Rights
Collaborative, Atlanta, GA), www.sistersong.net.
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The Women’s Health Activist (National Women’s
Health Network, Washington, D.C.),
www.womenshealthnetwork.org.
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The Health Advocate (National Health Law Program,
Los Angeles, CA), www.healthlaw.org.