Policy & Practice


Women Miss Pap Tests

About 14% of women aged 18-64 years had not receive a Pap smear in the last 3 years, according to 2005 data from the Agency for Healthcare Research and Quality. Health insurance was one factor: About 25% of women without health insurance failed to receive a Pap test in the last 3 years, compared with 11% of women covered by private insurance and nearly 15% of women with public insurance. Women with lower levels of education and single women also are more likely to go without a Pap test, according to the AHRQ data. The data are from the Medical Expenditure Panel Survey, which includes information on how Americans use health services. The U.S. Preventive Services Task Force recommends that all women aged 21-64 years receive a Pap test every 3 years to detect cervical cancer and abnormal cells.

N.H. Repeals Parental Notification Law

New Hampshire's parental notification law, which had been pending in the courts, has now been repealed. Gov. John Lynch (D) signed into law a bill officially repealing the requirement that physicians contact parents at least 48 hours before performing an abortion on a minor. The original parental notification requirement was enacted in 2003 and challenged by the American Civil Liberties Union and Planned Parenthood Federation of America. The case made its way to the U.S. Supreme Court and in 2006 the justices found that the law was unconstitutional because it lacked an exemption for medical emergencies. But the Supreme Court stopped short of striking down the law and instead sent it back to the lower court. The law was still being considered at the lower court level when it was repealed. “We are thrilled that New Hampshire has recognized the importance of protecting teenagers' health,” Corinne Schiff, a lawyer with the ACLU's Reproductive Freedom Project, said in a statement.

Breast-Feeding Protections in Pa.

Pennsylvania Gov. Ed Rendell (D) signed a bill into law that ensures that women who breast-feed in public cannot be charged with violating any state law or public ordinance. Under the “Freedom to Breastfeed Act,” breast-feeding cannot be considered indecent exposure, open lewdness, obscenity or sexual conduct, or a public nuisance. Pennsylvania is now one of 39 states with laws that specifically allow women to breast-feed in any public or private location, according to the National Conference of State Legislatures.

Ethics of Sterilization

Women considering sterilization should receive comprehensive counseling on the potential for future regret and the estimated failure rates and the risk of ectopic pregnancy, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Ethics. Women also should be encouraged to discuss the issue with their partners, the committee recommended. The committee opinion, which updates ACOG's position on sterilization, was published in the July issue of Obstetrics and Gynecology. However, physicians should be cautious in offering advice and making recommendations that go beyond the health issues, ACOG said, since nonmedical issues may be difficult to address without bias. The ethical issues become more complicated in women with mental disabilities. The presence of a mental disability alone does not justify either sterilization or the denial of the procedure, ACOG advised. However, physicians must evaluate the patient's ability to give informed consent. In those cases where informed consent cannot be obtained from the patient, the physician should try to ascertain the patient's views on reproduction and be aware of the possibility of undue pressure by family members. “Though sterilization is technically fairly straightforward, it can present serious ethical issues, especially when it comes to women with limited mental capacity,” Dr. Anne D. Lyerly, chair of the ACOG Committee on Ethics, said in a statement. “Physicians need to proceed with great care when they consider performing sterilization.”

CDC: 43 Million Lack Coverage

Nearly 15% of Americans–43.6 million–lacked health insurance in 2006, according to the Centers for Disease Control and Prevention. Among Americans aged 18 through 64, nearly 20% lacked health insurance in 2006, a slight increase from about 19% in 2005, the CDC said. About 9% of children did not have health coverage in 2006, a marked drop from 14% in 1997, the year the State Children's Health Insurance Program (SCHIP) was enacted. The CDC noted that the percentage of uninsured Americans in the 20 largest states varied from less than 8% in Michigan to nearly 24% in Texas. The CDC study was based on data collected from interviews in more than 100,000 households nationwide.

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