Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use.

PURPOSE: Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN: Cross-sectional online survey. SETTING: Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS: Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES: Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS: Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS: Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION: Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.

O marco inicial da vida humana: perspectivas ético-jurídicas no contexto dos avanços biotecnológicos / The beginning of human life: ethical and legal perspectives in the context of biotechnological progress / El marco inicial de la vida humana: perspectivas ético-jurídicas en el contexto de los avances biotecnológicos

Resumo: As indagações com relação ao termo inicial da vida humana perpassam a sociedade desde a antiguidade. No mundo pós-moderno, os avanços da ciência e da técnica potencializam as discussões acerca do tema, de modo que os debates que anteriormente se concentravam em torno do aborto, também passaram a ter como objeto as intervenções da biotecnologia. O presente artigo trata do último aspecto, a saber, refletir em que medida a dignidade humana pode ser considerada um referencial (hermenêutico) na construção de parâmetros ético-jurídicos para os avanços biotecnológicos na definição do marco inicial da vida humana. Para desenvolver a pesquisa, utilizou-se como método de abordagem a ética hermenêutica crítica, mediante a qual a ética encontra-se no centro do processo de compreensão e interpretação, observando-se os contornos da facticidade. Constatou-se que não há consenso no que diz respeito ao termo inicial da vida, de forma que é fundamental dialogar com a nova realidade decorrente dos avanços biotecnológicos, no processo de construção de preceitos éticos e jurídicos de proteção do embrião e da natureza humana, tendo como referencial a dignidade humana.

Abstract: Questions concerning the beginning of human life have pervaded society since antiquity. In the post-modern world, scientific and technological advances have fueled discussions on the issue, such that debates previously concentrated on abortion now also focus on biotechnological interventions. The article addresses the latter, reflecting on the extent to which human dignity can be considered a (hermeneutic) reference in establishing ethical and legal parameters for biotechnological advances in the definition of the beginning of human life. The study's method was critical hermeneutic ethics, with ethics at the center of the process of understanding and interpretation, observing the contours of facticity. No consensus was found on the beginning of human life, so it is essential to engage in dialogue with the new reality resulting from biotechnological advances in the process of defining ethical and legal principles for protecting the embryo and human nature, with human dignity as the reference.

Resumen: Las investigaciones relacionadas con el inicio de la vida humana han acompañado a la sociedad desde la antigüedad. En el mundo posmoderno, los avances de la ciencia y de la técnica potencian las discusiones sobre este tema, de modo que los debates que anteriormente se concentraban en torno al aborto, también pasaron a ser objeto por las intervenciones de la biotecnología. El presente artículo trata acerca de este último aspecto, a saber, reflexionar en qué medida la dignidad humana puede ser considerada una referencia (hermenéutica) en la construcción de parámetros ético-jurídicos para los avances biotecnológicos, en la definición del marco inicial de la vida humana. Para desarrollar la investigación, se utilizó como método de enfoque la ética hermenéutica crítica, mediante la cual la ética se encuentra en el centro del proceso de comprensión e interpretación, observándose los contornos de la facticidad. Se constató que no existe consenso en lo que se refiere al término inicial de la vida, de forma que es fundamental dialogar con la nueva realidad, derivada de los avances biotecnológicos, en el proceso de construcción de preceptos éticos y jurídicos de protección del embrión y de la naturaleza humana, teniendo como referente la dignidad humana.

Preventive and reproductive health services for women: the role of California's family planning waiver.

PURPOSE: Examine effects of a Medicaid family planning waiver on the receipt of reproductive health care and pregnancy. DESIGN: The present study uses a quasi-experimental design using data from the California Women's Health Survey and the Behavioral Risk Factor Surveillance System (BRFSS) for exposure and comparison groups, before and after California's Planning Access Care and Treatment waiver. SETTING: The setting was California and comparison states. SUBJECTS: The study included women who were ages 18 to 44 years and below 200% of the federal poverty level (FPL), who are eligible for services under the waiver. MEASURES: The study measured self-reported pregnancy and receipt of routine checkup, clinical breast exam, Pap test, Chlamydia screening, and discussion of birth control with provider in the past year. ANALYSIS: The study analyzes outcomes for exposure and comparison groups using probit regression models based on data both within California and in states without waivers. RESULTS: Estimates from the California Women's Health Survey analysis indicate that among parents 100% to 200% of the FPL, the waiver led to an 8-percentage point increase in the receipt of a routine checkup and a 12-percentage point increase (p = .03) in discussion of birth control. There was an estimated 3-percentage point decline (p = .05) in current pregnancies among nulliparous women. Multistate analysis using the BRFSS confirmed positive effects on routine checkups (p < .01). CONCLUSIONS: The waiver appears to have led to a reduction in pregnancy rates and increased receipt of reproductive health care, particularly routine checkups.

Medical tourism: reverse subsidy for the elite.

The medical tourism sector in India has attracted global attention, given its phenomenal growth in the past decade. India is second only to Thailand in the number of medical tourists that it attracts every year. Estimates indicate that the medical tourism market in India could grow from $310 million in 2005 to $2 billion by 2012. These figures are significant when contrasted with India's overall health care expenditure - $10 billion in the public sector and $50 billion in the private sector. Factors that have contributed to this growth include the relative proficiency in English among health care providers and the cost effectiveness of medical procedures in India. Generally, most procedures in Indian hospitals cost a quarter (or less) of what they would cost in developed countries. The expansion of medical tourism has also been fueled by the growth of the private medical sector in India, a consequence of the neglect of public health by the government. India has one of the poorest records in the world regarding public financing and provisioning of health care. A growing driver of medical tourism is the attraction of facilities in India that offer access to assisted reproductive care technologies. Ironically, this is in sharp contrast with the acute neglect of the health care needs of Indian women. The Indian government is vigorously promoting medical tourism by providing tax concessions and by creating an environment enabling it to thrive. However, there is a distinct disjunction between the neglect of the health care needs of ordinary Indians and public policy that today subsidizes the health care of wealthy foreigners.

Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients.

In this paper, we recommend expanding infertility insurance mandates to people who may become infertile because of cancer treatments. Such an expansion would ensure cancer patients can receive fertility preservation technology (FPT) prior to commencing treatment. We base our proposal for extending coverage to cancer patients on the infertility mandate in Massachusetts because it is one of the most inclusive. While we use Massachusetts as a model, our arguments and analysis of possible routes to coverage can be applied to all states' seeking inclusive coverage for infertility treatment. Furthermore, our proposal can also be applied to people with other diseases who may be rendered infertile by treatment.

HIV/AIDS, reproductive and sexual health, and the law.

The law is a frequently overlooked tool for addressing the complex practical and ethical issues that arise from the HIV/AIDS pandemic. The law intersects with reproductive and sexual health issues and HIV/AIDS in many ways. Well-written and rigorously applied laws could benefit persons living with (or at risk of contracting) HIV/AIDS, particularly concerning their reproductive and sexual health. Access to reproductive health services should be a legal right, and discrimination based on HIV status, which undermines access, should be prohibited. Laws against sexual violence and exploitation, which perpetuate the spread of HIV and its negative effects, should be enforced. Finally, a human rights framework should inform the drafting of laws to more effectively protect health.

Fertility services for human immunodeficiency virus-positive patients: provider policy, practice, and perspectives.

OBJECTIVE: To examine demand for, and access to, fertility services for HIV-positive patients in the United States. DESIGN: An electronic survey. SETTING: The URL for the Web-based survey was e-mailed to those surveyed. PATIENT(S): The 916 members of the Society of Reproductive Endocrinology and Infertility of the American Society of Reproductive Medicine. MAIN OUTCOME MEASURE(S): Policy and practice in evaluation and treatment of HIV-positive and HIV-serodiscordant couples who desire conception, demand for services, and perceived barriers to providing these services. RESULT(S): The response rate was 22%. Forty percent of respondents reported policies. Fifty-one percent reported requests. Sixty-four percent reported offering treatment to HIV-serodiscordant couples, and 57% reported offering treatment to HIV-positive couples. Treatments most frequently offered to HIV-serodiscordant male-positive couples were reproductive surgery (50%), ovulation induction (46%), and intracytoplasmic sperm injection (45%). Twenty-nine percent of those offering treatment test-washed specimens for HIV. Factors limiting care included the following: low volume of requests (45%), concern for child welfare (37%), no laboratory policy (32%), and legal risk (32%). CONCLUSION(S): Patients who are HIV-positive are seeking fertility services in the United States. The small demand is a major limiting factor to provision of services. There is a lack of global application of current American Society of Reproductive Medicine guidelines. Provider education is needed to ensure that the safest reproductive services are offered to HIV-positive patients. Legal reform is imperative to improve access to reproductive services for the HIV-positive population.

Ley de acceso universal y equitativo de servicios de planificación familiar y su integración en el Programa Nacional de Salud Reproductiva: decreto No. 87-2005 / Law on universal and equitable access to family planning services and their integration into the National Reproductive Health Program: decree No. 87-2005

Tiene por objeto asegurar el acceso de la población a los servicios de planificación familiar, que conlleve la información, consejería y educación sobre salud sexual y reproductiva a las personas y provisión de métodos de planificación familiar. Se establece también todo lo relativo a la difusión y formas de comunicación para lograr el cambio en el comportamiento, crea la Comisión Nacional de Aseguramiento de Anticonceptivos que tendrá como objeto velar por la disponibilidad de anticonceptivos para garantizar el acceso de la población a los servicios de planificación familiar, al mismo tiempo establece las funciones de dicha comisión y su forma de integración.. 25 artículos.

Ten years of democracy in South Africa: documenting transformation in reproductive health policy and status.

The advent of democracy in South Africa in 1994 created a unique opportunity for new lows and policies to be passed. Today, a decade later, South African reproductive health policies and the laws that underwrite them are among the most progressive and comprehensive in the world in terms of the recognition that they give to human rights, including sexual and reproductive rights. This paper documents the changes in health policy and services that have occurred, focusing particularly on key areas of sexual and reproductive health: contraception, maternal health, termination of pregnancy, cervical and breast cancer, gender-based and sexual violence, HIV/AIDS and sexually transmitted infections and infertility. Despite important advances, significant changes in women's reproductive health status are difficult to discern, given the relatively short period of time and the multitude of complex factors that influence health, especially inequalities in socio-economic and gender status. Gaps remain in the implementation of reproductive health policies and in service delivery that need to be addressed in order for meaningful improvements in women's reproductive health status to be achieved. Civil society has played a major role in securing these legislative and policy changes, and health activist groups continue to pressure the government to introduce further changes in policy and service delivery, especially in the area of HIV/AIDS.