TRAP

Attorney General Ken Cuccinelli sent the new rules for women's health centers back to the Board of Health. Make your voice heard at the September 14 meeting! 

One June 15, the Virginia Board of Health voted to amend a key provision of the proposed permanent regulations for women's health centers– the amendment means that existing women’s health care centers that provide safe, legal first-trimester abortion care will be "grandfathered in,” rather than being subjected to onerous and unnecessary forced building requirements.

On July 16, 2012, Attorney General Cuccinelli stated that his office refused to certify the Board’s vote. Thus, the proposed regulations will go back to the Board of Health for another vote on Friday, September 14. However, the Board can and should continue to vote in favor of medicine, not politics - the Attorney General does not have veto power over their decisions. On September 14, attend the Board of Health vote to demand  permanent regulations that protect women's health!

Date: Friday September 14, 2012

Time: The Board of Health meeting begins at 9 am

Join #OpposeTRAP at 7:30 am for an outside demonstration as Board members, Department of Health officials, and press arrive.

Location: Perimeter Center, 9960 Mayland Drive Richmond, VA

Make sure to RSVP here to tell the Department of Health to ensure enough room for the public.  

Timeline and key facts about the draft permanent regulations of women’s health care centers that provide abortion services in Virginia:  

·         In 2011, through an unrelated bill (SB 924), the Virginia House of Delegates changed the classification of women’s health care centers that provide first-trimester abortion (at least five performed per month) from “outpatient offices” to “hospitals.” This amendment was made by Rep. Kathy Byron, the same member of the Virginia legislature who proposed a new ultrasound requirement in 2011.

·         This change led to the drafting of “emergency” temporary regulations last fall, and now permanent regulations that require existing women’s health centers to come into compliance with three chapters of a manual called the 2010 Guidelines for Design and Construction of Health Care Facilities within the next two years. The guidelines are intended to apply only to new construction, not to existing facilities, and this is how they are applied to every other health care facility in Virginia.  They include:

o   Building 5-foot wide public hallways throughout the women’s health care centers

o   Constructing hospital-like treatment rooms up to 150 square feet in size 

o   Adding new covered front entrances, public telephones, public bathrooms and drinking fountains in waiting rooms, requiring new plumbing to accommodate

o   Incorporating specific new ventilation systems

• Against medical counsel, the Department of Health’s draft regulations’ building requirements also do not make the distinction between medically-induced abortion and an outpatient procedure; medically-induced abortion is completed with oral medication in a doctor’s office. 

• The draft guidelines also include provisions that compromise patient and health care center confidentiality, including allowing state inspectors to remove patient records from facilities. 

• Inspectors are also permitted to arrive at health care centers with only an hour’s notice at any hour of the day, seven days a week, a provision that is a burden to health care managers who work on a 9-to-5 schedule. No other medical procedure is regulated individually in this way in Virginia; physicians ultimately decide the appropriate setting for every other surgical procedure performed in Virginia.

 Impact of regulations: 

• Cost projected by the Department of Health for a 5,000 square-foot women’s health center: 

• Estimated cost of moderate renovations: $650,000
• Estimated cost for major renovations: $2.6 million
• Additional cost per patient: up to $250 per procedure, a 71 percent increase (based on an average of $350 per procedure)

• In some cases, women’s health care centers will be forced to build entirely new buildings, which may be cost-prohibitive.

Just one month ago, the governor of Minnesota vetoed a less restrictive TRAP bill, stating in his veto message: “The legislation targets only facilities which provide abortions. If regulation of clinics were the concern, the bill should have required licensure of all clinics, not just a select few…no clinic or procedure should be the focus of special and unique regulatory requirements.”

On June 15, the Virginia Board of Health voted to amend a key provision of the proposed permanent regulations for women's health centers– the amendment means that existing women’s health care centers that provide safe, legal first-trimester abortion care will be "grandfathered in,” rather than being subjected to onerous and unnecessary forced building requirements.

On July 16, 2012, Attorney General Cuccinelli stated that his office refused to certify the Board’s vote. Thus, the proposed regulations will go back to the Board of Health for another vote on Friday, September 14. However, the Board can and should continue to vote in favor of medicine, not politics - the Attorney General does not have veto power over their decisions. On September 14, attend the Board of Health vote to demand permanent regulations that protect women's health!

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Planned Parenthood Advocates of Virginia
PO Box 7271
Richmond, VA 23221

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Abstinence-Only Programs

Since 1996, the United States has wasted more than $1.5 billion in federal and state funding on abstinence-only programs that fail to teach teens how to prevent pregnancy or sexually transmitted infections (STIs).

A 10-year government study found that abstinence-only programs did not delay sexual initiation or lower rates of pregnancy or STIs, and the Institute of Medicine called for the termination of abstinence-only programs because they represented “poor fiscal and public health policy.”

By providing misinformation and withholding accurate information that young people need in order to make informed choices, abstinence-only programs deny young people life-saving information.

Read our fact sheet on abstinence-only programs.

Visit our Sex Education resource section for further information about failed abstinence-only programs.

Case Study: Affordable Birth Control

By 2007, a legislative error made by Congress two years earlier had caused the price of birth control to increase by as much as 900 percent for low-income women and college students across the country. In many cases, these women could no longer afford to protect themselves from unintended pregnancy.

All people deserve access to birth control — not just those who can afford it. As birth control prices soared, Planned Parenthood launched its Affordable Birth Control Campaign to mobilize students and other activists across the country and gain crucial support in Congress to solve the problem. (Click here to view a video from the campaign).

College students from nearly 300 college campuses in 45 states across the country joined Planned Parenthood in Washington, DC, to tell their members of Congress stories about how they had been affected by rising birth control costs. And more than 50,000 supporters across the country showed their support for the Affordable Birth Control Campaign.

Success
In March 2009, Congress stood up for women and passed a no-cost provision in an appropriations bill to ensure access to affordable birth control. President Obama, a strong supporter of this commonsense fix who, as a senator, had sponsored legislation to restore access to affordable birth control, signed the bill on March 11, 2009.

IN THE NEWS

The Planned Parenthood Affordable Birth Control Campaign generated extensive positive news coverage. From national stories in The New York Times, Los Angeles Times, and U.S. News & World Report, to reporting by campus newspapers, the media recognized that the affordable birth control crisis was a crucial issue.

Read and watch the widespread coverage of the Planned Parenthood Affordable Birth Control Campaign.

State Medicaid Programs and Pregnancy Prevention

What if our government had the power to prevent hundreds of thousands of unintended pregnancies and abortions every year — and, in the process, could save millions of dollars in annual spending? While such a scenario may sound too good to be true, these outcomes are easily within reach if federal and state governments expand Medicaid coverage for contraception.

Every state Medicaid program currently covers pregnancy care for low-income women (those with incomes below 133 percent of the federal poverty level — just under $30,000 for a family of four). In fact, Medicaid pays for 41 percent of all births in the United States. But in many states, low-income women seeking to plan their pregnancies may be unable to access contraceptives and other family planning services.

• The Guttmacher Institute estimates that a low-income woman in the United States, compared to her higher-income counterpart, is 
  • nearly four times as likely to have an unintended pregnancy 
  • five times as likely to have an unintended birth 
  • more than three times as likely to have an abortion

• Four in 10 low-income women of reproductive age have no insurance; more than six in 10 are not covered by Medicaid.
• Establishing equality between pregnancy coverage and family planning coverage would not only expand access to contraceptives, but it would also increase access to basic preventive health care for women. Breast and cervical cancer screening, blood pressure testing, pelvic exams, and screening for sexually transmitted infections, including HIV, are all covered services under a Medicaid women’s health care visit. In addition, these basic health care visits often serve as the entry point into the health care system for millions of women. Among women patients below the federal poverty level, seven in 10 consider a women’s community health provider, like Planned Parenthood, their primary source of health care.
• During these difficult economic times, states are being forced to cut their women’s health care programs just as more families need access to quality, affordable health care. In fact, more than 17 million women need publicly funded reproductive health care, and with more women losing their health insurance along with their jobs, this number will likely continue to increase.
• Women are the primary health care decision makers in most families, and their own health care is often the first to be dropped. More than half of women report cost-based difficulties in accessing health care, and one-third of women report not filling a prescription because of cost.

SUCCESSES

• Many states have already increased access to family planning services under Medicaid, though they’ve done so with great difficulty. Since the early 1990s, 27 states have expanded Medicaid family planning coverage to women and sometimes men who would not otherwise be eligible for Medicaid services. In order to implement these expansions, states must currently obtain special permission from the federal government, and this process can be cumbersome and expensive for states.  
• States that have expanded coverage of family planning services under Medicaid have seen excellent outcomes — both in expanded access to services and reduced costs.  
  • In 2005–2006, California’s family planning program (the nation’s largest) helped women avoid 248,000 unintended pregnancies.
  • Every dollar spent on reproductive health care saves $4 in Medicaid-related costs alone.

Planned Parenthood supports federal legislation that would create a state option for Medicaid family planning coverage. This small but important change in federal law would give states the flexibility to expand family planning coverage without having to navigate the burdensome approval process currently in place. We support a state option to expand coverage for family planning services up to the income level at which pregnancy-related care is covered under Medicaid. This would make it much easier for states to adopt these proven-effective expansions of coverage.

It is critical that Congress act quickly to pass this commonsense legislation and improve states’ ability to meet the basic health care needs of women and their families.

Insurance Coverage for Birth Control

More than 38 million American women currently use birth control, and nearly all (98 percent) sexually active American women have used birth control at some time in their lives. Yet far too many insurance policies do not cover the cost of this basic health care need.

In the courts and in Congress, at the federal level and in the states, Planned Parenthood is a leader in the movement to guarantee insurance coverage for contraceptives. In 1998, Planned Parenthood won a major legislative victory with the requirement that prescription contraceptive drugs and devices be included in insurance coverage for all employees of the federal government. Now we are working with our allies to ensure that Congress and state legislatures pass laws guaranteeing insurance coverage for birth control in the private market. 

More than half of the states require insurers that provide prescription drug coverage to also cover contraceptives, but it is imperative that all women have this important benefit. The lack of insurance coverage is costly — for insurers who may end up paying the costs of childbirth or abortion, and for women whose physical and financial well-being may be undermined by an unintended pregnancy.

340 B Program-Helps Low-Income Individuals and Their Health Care Providers

In 1992, Congress established the 340B program to help health care providers serve low-income people. The law requires pharmaceutical manufacturers participating in the Medicaid program to provide discounts  on covered outpatient drugs purchased by participating essential community providers.

The 340B program serves as an important foundation for designated health care providers, which rely on the significantly reduced prices offered by pharmaceutical companies to stretch scarce dollars and ensure that low-income, uninsured, and underinsured Americans have access to affordable, quality health care.

Women’s health centers, like Planned Parenthood affiliate health centers, have struggled to keep pace with the rising cost of providing care, including the dramatically increasing price of prescription drugs. In order to ensure that patients can continue to access primary health care services, Planned Parenthood urges Congress to update the 340B program to include women’s health centers that are not currently eligible for the program but that make up a critical component of our nation’s community health providers.

Title X: America's Family Planning Program

Title X has been key to helping millions of American women prevent unintended pregnancies and obtain reproductive health care for almost four decades.

The Title X family planning program began in 1970 as a bipartisan commonsense approach to ensuring that low-income Americans have access to contraceptive services and other preventive health care. For almost 40 years, Title X has been the nation's only program dedicated solely to reducing unintended pregnancy by providing contraceptive and related reproductive health care services to low-income women. In fact, Title X supports six in 10 of all family planning health centers in the United States, and Title X funds account for 24 percent of those health centers' total revenue (Frost, 2006; Fowler, et al., 2008).

Title X is a vital source of funding for family planning health centers throughout the nation.

All Title X grants are administered from the federal government to more than 80 grantees, who then distribute the funds to the approximately 4,480 health centers in the program (Fowler, et al., 2008). Many Planned Parenthood health centers play an integral role in the success of the Title X program. In fact, one analysis showed that of the women served by the program, 43 percent received care at health departments, 33 percent received care at Planned Parenthood health centers, 13 percent received care at other independent community-based clinics, seven percent received care at hospitals, and four percent received care at community or migrant health centers (Guttmacher Institute, 2004; Frost, et al., 2004). Title X also upholds important standards of care for those individuals who want reproductive health care. The law's provisions include requirements that

• people be given a choice of contraceptive methods (including periodic abstinence and other fertility awareness-based methods)
• no one is coerced into accepting a particular method or any method at all
• services are provided in the context of related reproductive health care
• recipients are charged fees based on their income and ability to pay

By law, no Title X funds are used for abortion services. (P.L. 91-572, 1970).

Title X Services

Title X funds services essential for the health of women and their families.

The Title X program provides comprehensive family planning services that include a broad range of contraceptive methods and related counseling. The official program guidelines also require health care providers that receive this funding to offer a wide range of other preventive health care services that are critical to their clients' sexual and reproductive health (Gold, 2001). These services include

• pelvic exams and Pap tests (early detection of cervical cancer)
• breast exams and instruction on breast selfexamination
• testing for high blood pressure, anemia, and diabetes
• screening and appropriate treatment for sexually Transmitted Infections
• Safer-Sex Counseling
• Basic infertility screening
• referrals to specialized health care (Gold, 2001).

By law, no Title X funds have ever been spent on abortion(Sollom, et al., 1996). Keeping in line with basic standards of medical care, however, Title X regulations require that women who face unintended pregnancies be given nondirective counseling on all of their legal and medical options, including prenatal care and delivery, infant care, foster care or adoption, and pregnancy termination (Federal Register, 2000).

Title X Recipients

Title X-funded health centers serve about five million patients a year who might otherwise be unable to afford family planning(Fowler, et al., 2008). Patients served at Title X health centers are predominantly low-income, uninsured young women. In 2006, approximately 4.7 million women received health care services at Title X family planning health centers. Sixty-seven percent of patients have incomes at or below the federal poverty level, and 61 percent are uninsured. Seventy-four percent of women using Title X-funded clinics are 20 or older (Fowler, et al., 2008). It is estimated that these clinics are the only source of family planning services for more than 80 percent of the women they serve (Kaeser, et al., 1996).

According to regulations, the amount a woman pays for family planning services at a Title X-funded clinic depends upon her income. If her income is at or below 100 percent of the federal poverty level, the services are completely subsidized. A woman will be charged on a sliding fee scale if her income is between 100–250 percent of poverty level, and she will pay full fees if her income is above 250 percent of poverty level (Kaeser, et al., 1996).

From the beginning, America’s family planning program has also required that services be made available without regard to age or marital status. In 1977, family planning services — including the availability of contraception — were extended to minors under the age of 16 as a result of the U.S. Supreme Court's decision in Carey v. Population Services International (Carey v. Populations Services International, 1977). As a result of this court decision, clinics supported by Title X funds have traditionally served adolescents on a confidential basis. Clinics also provide preventive educational services to young people, including an emphasis on the postponement of sexual activity, as well as counseling and contraceptive care. Counselors in most family planning clinics are encouraged to spend extra time with teenage clients (Henshaw & Torres, 1994). Title X clinics are required by law to encourage minors to involve their parents in their decision-making regarding family planning (P.L. 108–447, 2005).

More than 30 Years of Title X Successes

Family planning programs are successful in preventing unintended pregnancies.

By providing access to contraceptive methods and counseling on how to use them effectively, family planning health centers — many of which receive funding through Title X — have been shown to reduce large numbers of unintended pregnancies. In fact, Title X health centers help women prevent one million unintended pregnancies each year (Dailard, 2001).

Each public dollar spent to provide family planning services saves an estimated $3 that would otherwise be spent in Medicaid costs for pregnancy-related care and medical care for newborns (Forrest & Samara, 1996). A study that measured the cost of contraceptive methods compared to the cost of unintended pregnancies when no contraception was used found the total savings to the health care system to fall between $9,000 and $14,000 per woman over five years of contraceptive use (Trussell, et al., 1995).

Title X has made a tremendous impact in the lives of millions of women. Over the last two decades, services provided at Title X-funded clinics

• prevented 20 million unintended pregnancies
• helped to prevent 5.5 million adolescent pregnancies. (Without Title X, there would have been 20 percent more teen pregnancies during this time period.)
• provided an estimated 54.4 million breast exams and 57.3 million Pap tests, resulting in the early detection of as many as 55,000 cases of invasive cervical cancer (Gold, 2001).

In 2006, Title X providers performed more than 2.4 million Pap tests, 2.4 million breast exams, and 5.2 million tests for sexually transmitted infections (STIs), including 666,706 HIV tests (Fowler, et al., 2008).

Continued Need for Title X

Family planning programs continue to provide essential services to women seeking to plan their pregnancies and maintain their health.

A 1995 report on unintended pregnancy by the Institute of Medicine noted with concern the increasing number of births from unintended pregnancies in the early 1990s. It urged that financial barriers to contraceptive services be reduced, and that public funding — including Title X specifically — should continue, especially for low-incomewomen and adolescents. The report pointed to the serious public health consequences that result from a lack of family planning services:

• A woman with an unintended pregnancy is less likely to seek early prenatal care and is more likely to expose the fetus to harmful substances such as alcohol and tobacco.
• Births from unintended pregnancies are more likely to occur to mothers who are adolescent or over age 40 — characteristics that carry special medical risks.
• The U.S. ratio of about one abortion to every three live births is two to four times higher than in other developed countries, although access to abortion in those countries is often easier than in the U.S. (Institute of Medicine, 1995).

While family planning programs have helped to increase the percentage of adolescents who use contraception at first intercourse (79 percent in 2002), there is still a great need for Title X (NCHS, 2004a). A recent evaluation of the National Survey of Family Growth has shown that the number of women at risk of unintended pregnancy due to a lack of contraception has increased to 10.7 percent (NCHS, 2004b). According to the Office of Population Research, this could potentially lead to an 18 percent increase in unintended pregnancies ("Teens Improve ...", 2005).

Public Support for Family Planning

The majority of Americans supports increased public funding for services to prevent unintended pregnancies.

Publicly funded family planning programs enjoy overwhelming public support. According to research conducted for Planned Parenthood, 67 percent of voters strongly support launching a major effort to reduce the number of unintended pregnancies through commonsense measures increasing access to contraception and comprehensive sex education (Peter D. Hart Research Associates, 2007).

Funding for Title X

In spite of its proven track record as a cost-effective program for preventing unintended pregnancies and improving the health of women, Title X faces threats from Congress to cut funding or attach harmful restrictions, making it less likely that people will receive the care they need. Title X lost a significant amount of funding during the 1980s, and while appropriations increased during the Clinton administration, the decreased purchasing power of the dollar meant that the program was operating with less money each year. In fact, the Title X program is $425 million short of keeping up with inflation (NFPRHA, 2008).

President Bush has not proposed any increase in Title X funding since taking office in 2001. Because the program has remained underfunded for so long, health centers are struggling to pay for newer, more effective — but more costly — methods of contraception and stateof- the-art diagnostic tests that promise improved rates of detecting STIs and cervical cancer.

Recent Threats to Title X

Since the inception of Title X, opponents of family planning have long tried to use the issues of abortion and the reproductive rights of minors to attack the family planning program.

In October 1998, members of the House attempted to pass legislation restricting minors’ access to family planning services. Representative Ernest Istook (R-OK) proposed an amendment to the Labor, Health and Human Services and Education Appropriations Act of 1999 mandating that the parents of dependent teenagers be notified before their children receive contraceptives from Title X clinics (Congressional Record, 1998). Supporters of parental consent argue that the availability of confidential contraceptive services encourages teenage sexual activity and undermines parental authority. However, research shows that confidentiality is crucial to teens’ willingness to seek sensitive services such as family planning (Jones, et al., 2005; Reddy, et al., 2002). Moreover, the fact that the average teen does not visit a family planning clinic until 14 months after she has become sexually active provides clear evidence that clinics do not encourage sexual activity. In fact, requiring parental consent will not discourage teens from having sex but will only deter them from seeking needed reproductive health care in a timely manner (Guttmacher Institute, 2000). A recent study has shown that 20 percent of adolescent girls currently visiting family planning clinics for contraceptive services would have unsafe sex instead of accessing birth control through a clinic if mandatory parental notification laws went into effect. Only one percent of the adolescents surveyed said that they would remain abstinent if their parents were notified of their visits to the family planning clinic (Jones, et al., 2005). Fortunately, the Istook amendment was dropped from the final bill and never became law (Guttmacher Institute, 2000).

In 2005, Rep. Dave Weldon (R-FL) successfully tacked a so-called "Abortion Non-Discrimination Act (ANDA)" on to the federal government's budget. Proposed by the U.S. Conference of Catholic Bishops, the Weldon Amendment allows virtually any health care institution to refuse to comply with existing federal, state, and local laws and regulations pertaining to abortion services, including referral for abortion services (Feldt, 2004). Health care institutions, as defined by the law, include hospitals, provider-sponsored organizations, health maintenance organizations, health insurance plans, or any other kind of health care facilities, organizations or plans (PPFA, 2004). ANDA seriously undermines Title X by prohibiting the federal government from enforcing its own requirement that Title X-funded clinics must refer clients to abortion providers upon request. The State of California is currently taking legal action to challenge this legislation.

Family planning opponent Rep. David Vitter (R-LA) has continuously introduced legislation and offered amendments to the pending appropriations legislation designed to undermine Title X and access to family planning services. The Vitter amendments would have prevented private organizations from receiving Title X funds to provide contraception and other preventive health care services even though they provide abortions or abortion related services with their own, non-Title X funds — in accordance with federal law. Had these amendments succeeded, it would have restricted the funding availability of contraceptives and other preventive health care affecting one million low-income women by prohibiting nearly 600 hospitals, Planned Parenthood affiliates, and other established health care providers from receiving Title X funds (Gold, 2000). Vitter's attacks would have endangered the health of low-income women, and threatened the Title X family planning clinic network.

Title X has a long and remarkable history. It has enabled millions of women to plan their pregnancies, to prevent unintended births, and to receive vital reproductive health care. For the benefit of American families, funding of Title X must continue to be a national priority, and Planned Parenthood is proud of the role it has played in preserving this crucial women’s health program.

History of the Federal Abortion Ban

• 1995–96: Congress passes the first nationwide ban on abortion in 1995, which is vetoed by President Bill Clinton in 1996. Although abortion foes are able to override the president's veto in the House, senators sustain the president's action and prevent the act from becoming law.
• 1997: Congress passes a slightly amended version of the law, which is again vetoed by President Clinton.
• 1999–2000: The Senate and House again pass the 1997 version of the abortion ban. But when the congressional session ends, the bill dies.
• 2002: A new abortion ban is passed in the House of Representatives.
• 2003: Congress passes and President George W. Bush signs the first federal law banning second-trimester abortions. 
• 2003: Enforcement of the federal ban is blocked as a result of three lawsuits filed in federal courts in California (brought by Planned Parenthood Federation of America on behalf of its member affiliates), Nebraska (brought by the Center for Reproductive Rights on behalf of Dr. LeRoy Carhart and other doctors), and New York (brought by the American Civil Liberties Union and Wilmer Cutler & Pickering LLP on behalf of the National Abortion Federation and other doctors).  
• 2004–2005: The U.S. District Courts and U.S. Courts of Appeals in all three cases declare the federal abortion ban unconstitutional. 
• June 20, 2006: In response to the requests of U.S. Attorney General Alberto Gonzales, the Supreme Court grants review of two of the appeals courts’ decisions striking down the federal abortion ban.
• April 18, 2007: The U.S. Supreme Court upholds the federal abortion ban, which criminalizes abortions in the second trimester of pregnancy that doctors say are safe and the best to protect women’s health.