Sunday, November 05, 2006

Pregnant Women Support Act

In a previous post, I mentioned that I would provide some summary information on the Pregnant Women Support Act. I finally had time to wade through the bill (HR6145), so here are some details.

The findings (essentially the case for why the legislation is needed) are as follows:
1) There are 1.29 million abortions annually in America.
2) 48% of all pregnancies in America are unintended. Excluding miscarriages, 54% of unintended pregnancies end in abortion.
3) 57% of women who have abortions have incomes below 200% of the poverty level.
4) "Cannot afford a baby" is the second most frequently cited reason women choose to have an abortion; 73% of women having abortions cited this reason as a contributing factor.
5) This Act is an initiative to gather more complete information about abortion, to reduce the abortion rate by helping women carry their pregnancies to term and bear healthy children, and by affirming the right of women to be fully informed about their options when they seek an abortion.
6) The initative will work to support women facing unplanned pregnancies, new parents and their children by providing comprehensive measures for health care needs, supportive services and helpful prenatal and postnatal services.

Unfortunately, the statistics presented above do not appear to be cited in any way in the document. They do seem to correspond approximately with data I found on the Guttmacher Institute website; the most recent data from the CDC is from 2002. However, the data seems to be questionable, as a Health United States report gives two figures for 2002: 854K from the CDC, and 1.29 million from the Guttmacher Institute, with the difference reportedly being that Alaska, California, and New Hampshire did nto report this data to the CDC for 2002.

Moving on, with some notable highlights...
  • "The Secretary shall enter into an agreement with the Institute of Medicine to study the reasons why women choose to have an abortion. The Secretary shall ensure that a report from the Institute describing the findings of the study is submitted to the Congress not later than January 10, 2010."
    I'm looking forward to seeing this, although it seems like it might have been more efficient to conduct a study on why women have abortions prior to introducing legislation purporting to reduce them.
  • "IN GENERAL.—Health facilities that perform abortions in or affecting interstate commerce shall obtain informed consent from the pregnant woman seeking to have the abortion. Informed consent shall exist only after a woman has voluntarily completed or opted not to complete pre-abortion counseling sessions."
    Informed consent is good, and one hopes it's already in place everywhere.
  • "Counseling sessions under subsection (a) shall include the following information: (1) The probable gestational age and characteristics of the unborn child at the time the abortion will be performed. (2) How the abortion procedure is performed. (3) Possible short-term and long-term risks and complications of the procedure to be performed. (4) Options or alternatives to abortion, including, but not limited to, adoption, and the resources available in the community to assist women choosing these options. (5) The availability of post-procedure medical services to address the risks and complications of the procedure."
    Not sure what is meant by "characteristics." Otherwise, everythiing else seems like standard practice. Civil remedies will be available where informed consent was not obtained.
  • There are several provisions in Title IV of the bill that prohibit insurers from imposing preexisting condition exclusions on pregnancy or denying coverage on the basis of pregnancy, requires insurers to notify women about adding their newborn to their coverage, etc.
  • "The Secretary may make grants for the purchase of ultrasound equipment. Such ultrasound equipment shall be used by the recipients of such grants to provide, under the direction and supervision of a licensed medical physician, ultrasound examinations to pregnant women consenting to such services."
    Grantees are required to be eligible for Public Health Service Act funds, offer women the option of viewing the ultrasound images, and inform women that they have the right to know the general anatomical and physiological characteristics and approximate age of the fetus. I suspect this is a way to increase funding to "crisis pregnancy centers," where the ultrasound is not really being used for medical purposes, but as a tool to steer women into making a specific choice, not necessarily their own choice.
  • Provides services to patients receiving Down Syndrome or other prenatal diagnosis - women should receive "scientific, and nondirective counseling" about the conditions and accuracy of tests. The purpose of this section is described as increaseing patient referrals to support services for women who have received a positive diagnosis, ensure that patients receive accurate information, and approve data availability. They would establish a phone hotline and website for patients, national and local peer-support programs, a national registry of families willing to adopt newborns with this type of condition, and establishment of a clearinghouse of information on thse conditions, and education programs for healthcare providers.
    Education is good. Scientifically accurate information is good. Undue pressure to put up children for adoption is not good. Be careful there, fellows. (I just read "The Girls Who Went Away" - review coming soon)
  • States may obtain funding for a separate program for domsetic violence, dating violence, sexual assault, and stalking screening and treatments for pregnant women and new mothers. This would include training health professionals to identify and respond to patients experiencing abuse, and ensuring that services are provided in a "linguistically and culturally relevant manner." $4,000,000 would be authorized for appropriation for each of the fiscal years 2007-2011.
  • States could receive grants "to increase public awareness of resources available to pregnant women who intent to carry their pregnancy to term and to new parents." This would cover identification of resources, advertising campaigns, establishment of a hotline to direct people to support services, adoption centers, and organizations that provide support to new parents.
  • Grants (not to exceed $25K) to public higher education institutions (read: state colleges and universities) to assist pregnant students who intend to carry their pregnancies to term through on-campus facilities. There is also mention of grants for child care for parenting students, although the details are not entirely clear.
  • Grants to states for early childhood education programs (including Head Start) to work with pregnant/parenting teens to complete high school and prepare for further education.
  • Title XI provides for grants to homes for pregnant and parenting women. The group homes must provide upon request adoption counseling and counseling on parenting skills.
  • Would expand adoption credit to $15K from $10K, with increases for inflation
  • Authorizes appropriations to WIC of $5,388,000,000 for FY 2007, $15,000,000 of which would go for breastfeeding peer counselors, $14 million for "infrastructure" and $30 million for management information systems.
  • I'd like to see those last two spelled out a little better.
  • Grants can be made to local health departments to provide eligible mothers with free home visits by registered nurses. "Eligible" means the infant is 12 months old or less, the woman was <20yo at time of birth, and the infant is the first child of the mother.

    I'm on board with all of the post-birth assistance, referral to community services, consent, education, and promotion of breastfeeding. I do think this bill does some very worthwhile things, and at least partially addresses the old argument that if you want to reduce abortions, you have to make it easier for women to have children and support them after birth. On the other hand, the folks involved with this bill have proposed it as a means to reduce abortion, and I don't see a single thing in it about comprehensive sex education (big surprise) or contraceptives. There is nothing in here that addresses preventing pregnancy in the first place. Also, I think it's good if more women are referred to appropriate community agencies, but outside of the public health and Head Start things, I don't see an increase in funding for existing providers. If they suddenly become swamped with women, will they be able to afford it, and will women receive good service? I also see that universities and schools have the option to apply for grants to help their childbearing students complete school, but I wonder how many of these institutions will have the time and resources to put such grant applications together and follow up with good programming. There is nothing automatic here, but hopefully some of the schools will apply. With regards to high school students, the language states that the money is for early childhood education programs, but is not clear on whether high schools can directly receive these funds. I also don't see much that truly makes it easier for women to afford to have a baby, because there isn't a lot of substantial funding increase for prenatal care, the actual birth, or all the expenses that come with children (especially after the first year covered by the home visits, which are education rather than medical in any care). The WIC increase is not an increase in the amount of money women can get to actually feed their children. Finally, this legislation could be read as an attempt to push women into carrying a pregnancy to term (even when there is a serious genetic defect - the language beyond Down Syndrome is very vague) and giving up the child for adoption, while it does not in any way address the psychological consequences or provide post-surrender counseling for these women. It will be interesting to see how this plays out. Talk to Action also has interesting commentary on this.

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    MeSH Tags: Legislation; Pregnancy; Social Work
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