What to Consider About Contraception and Pregnancy After Roe v. Wade Is Overturned
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Period Poverty: Raising Awareness About An Overlooked Global Issue
California Women Will Soon Be Able to Get a Year's Supply of Birth Control
California, Washington Sue Johnson & Johnson Over Pelvic Mesh Implants
Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation
How One Hospital Brought Its C-Section Rate Down In A Hurry
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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"lisafine":{"type":"authors","id":"11105","meta":{"index":"authors_1591205172","id":"11105","found":true},"name":"Lisa Fine","firstName":"Lisa","lastName":"Fine","slug":"lisafine","email":"lisacfine@gmail.com","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Lisa Fine is a veteran journalist who's written for papers including the Washington Post, Philadelphia Inquirer, Richmond (Va.) 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Wade Is Overturned","publishDate":1656098156,"format":"standard","headTitle":"NPR | KQED News","labelTerm":{},"content":"\u003cp>Access to a safe abortion already varies depending on what state you live in. Now that the Supreme Court has overturned Roe V. Wade, the landmark Supreme Court decision that's protected abortion rights since 1973, the \u003ca href=\"https://www.npr.org/2022/05/04/1096719943/some-states-will-ban-abortion-others-will-expand-access-if-roe-v-wade-is-overtur\">options will become even more limited – or virtually non-existent – in many states\u003c/a>.\u003c/p>\n\u003cp>There are potential implications for reproductive health well beyond abortion – including types of birth control, fertility treatments and treatments during pregnancy. Many people may have to rethink – or think more intentionally about – decisions they've long taken for granted.[aside postID=news_11917111 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/06/RS55728_073_KQED_AbortionRallySF_05032022-qut-1-1020x679.jpg']Here's what you need to know about birth control, emergency contraception and terminating a pregnancy.\u003c/p>\n\u003ch2>Consider \"layering\" contraceptive methods\u003c/h2>\n\u003cp>\u003ca href=\"https://www.cdc.gov/reproductivehealth/contraception/index.htm#Contraceptive-Effectiveness\">Different types of birth control have different rates of failure\u003c/a> – meaning, contraception does not 100% guarantee that you won't get pregnant if you're having sex. Your choice of birth control might depend on the associated side effects, whether your healthcare provider or local pharmacy keeps it in stock, if you have insurance, what your insurance covers and a method's efficacy.\u003c/p>\n\u003cp>Once you decide \u003ca href=\"https://www.npr.org/2020/02/19/807328672/trying-to-decide-what-birth-control-to-use-heres-how-to-make-the-decision\">what type of birth control works for you\u003c/a>, consider whether you need to take extra precautions if you don't want to get pregnant.\u003c/p>\n\u003cp>Dr. Katharine White, \u003ca href=\"https://www.drkatewhite.com/yoursexualhealth/\">an associate professor at Boston University's school of medicine and author of the book \u003cem>Your Sexual Health\u003c/em>\u003c/a> recommends \"layering\" certain methods: if condoms are your primary method of birth control, consider also using the withdrawal method and/or tracking your ovulation so that you know when you're most fertile.\u003c/p>\n\u003cp>\"I call this the BLT approach because it involves stacking methods on top of each other,\" like a bacon-lettuce-tomato sandwich. \"Together, these can be very highly effective,\" says Dr. White.\u003c/p>\n\u003cp>Any birth control, Dr. White says, will be \"much more effective than crossing your fingers hoping that you don't get pregnant.\"\u003c/p>\n\u003ch2>You can keep emergency contraception on hand in case you need it\u003c/h2>\n\u003cp>If your primary birth control fails or if you have unprotected sex and want to prevent pregnancy, you may find yourself at the pharmacy for emergency contraception.\u003c/p>\n\u003cp>Plan B and other emergency contraceptive pills are\u003cstrong> not the same\u003c/strong> as an abortion pill – \u003ca href=\"https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/access-to-emergency-contraception\">emergency contraception prevents someone from getting pregnant in the first place\u003c/a>.[aside postID=news_11913295 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS55729_078_KQED_AbortionRallySF_05032022-qut-1020x680.jpg']Plan B is one of the most popular brands, but you can find a number of over-the-counter emergency contraceptives with levonorgestrel. You can also ask your provider to prescribe you Ella, an emergency contraceptive pill with ulipristal acetate.\u003c/p>\n\u003cp>\u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/emergency-contraception\">Emergency contraception can prevent more than 95% of pregnancies\u003c/a> when taken within three to five days of unprotected sex. But the sooner you take it, the more effective it is. Many sexually active people keep some on hand in their medicine cabinet as a precautionary measure.\u003c/p>\n\u003cp>Check the expiration date – it's typically several years out, but the pill becomes less effective after it expires. Because of the long shelf-life, you can stock up responsibly in case supplies get short.\u003c/p>\n\u003cp>If you find yourself using emergency contraceptives frequently, consider a different primary method of birth control.\u003c/p>\n\u003cp>\"If someone finds that they're needing to take it often ... [like] more than once in a month or in one menstrual cycle, it may not be as effective because the way it works is to delay ovulation,\" says \u003ca href=\"https://powertodecide.org/\">Dr. Raegan McDonald-Mosley, a practicing OBGYN and the CEO of Power to Decide\u003c/a>, a sexual health and planning nonprofit group.\u003c/p>\n\u003ch2>If you have an unplanned pregnancy, online resources can help find the right option for you\u003c/h2>\n\u003cp>If a home pregnancy test shows that you're pregnant, trust it – \u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940\">it's rare to get a false-positive\u003c/a>. If you're faced with an unwanted pregnancy, most states require you to act quickly.[aside postID=news_11917541 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/06/Lee-Mitchell_IMG_0090-2-1020x728.jpg']If you live in a state that has severely restricted or eliminated access to abortion, \u003ca href=\"https://www.abortionfinder.org/\">you can find your nearest clinic through Power To Decide's abortion finder\u003c/a>. Going to a clinic that provides abortions does not necessarily mean you will have an abortion, Dr. McDonald-Mosley says. You can make an appointment to confirm a pregnancy and discuss your options with a professional, including information about childcare services.\u003c/p>\n\u003cp>For a lot of people, traveling out of state to an abortion clinic is prohibitively expensive. The \u003ca href=\"https://wrrap.org/\">Women's Reproductive Rights Assistance Project (WRRAP)\u003c/a> or the \u003ca href=\"https://www.ineedana.com/about\">I Need a Database\u003c/a> can show you clinics in your area and link you to local organizations that can help with funding.\u003c/p>\n\u003cp>If you can't travel to a clinic or prefer to manage your own abortion, \u003ca href=\"https://aidaccess.org/en/\">you can get care online through aidaccess.org\u003c/a>. The site provides online consultations for abortions and medication from overseas.\u003c/p>\n\u003cp>\"Those pills are the exact same medication as we provide in our clinic,\" says Robin Marty, the operations director at the \u003ca href=\"https://alabortionclinic.com/\">West Alabama Women's Center\u003c/a>. Like with any medication, there can be health risks with getting medication online – and Marty cautions that \u003ca href=\"https://www.reprolegalhelpline.org/self-managed-abortion-and-the-law/\">depending on where you live, there may be legal repercussions\u003c/a> involved in seeking abortion pills or inducing an abortion at home.\u003c/p>\n\u003cp>Be sure to look up your state's laws about managing your own abortion before you make your decision. There are \u003ca href=\"https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html\">numerous resources online\u003c/a> that explain each state's laws \u003ca href=\"https://www.plannedparenthoodaction.org/abortion-access-tool/CO\">regarding abortion restrictions there\u003c/a>.\u003c/p>\n\u003cp>Seek professional medical care from a local clinic, your doctor or a local urgent care if you experience prolonged bleeding or other complications after taking medication to manage an abortion.\u003c/p>\n\u003cp>Complications from a medical abortion look very much like a miscarriage, says Dr. McDonald-Mosley. \"So someone can potentially present to an emergency room or to their provider and say, 'I'm having cramping and bleeding and I had a positive pregnancy test,' and receive the care that they need without having to reveal that they have taken abortion medications.\"\u003c/p>\n\u003ch2>If you're planning to get pregnant, talk to your provider early about your options, in case of complications\u003c/h2>\n\u003cp>Sometimes, even planned pregnancies end in abortion due to complications that can pose a risk to the pregnant person, or a fetal anomaly that will result in the baby's death.\u003c/p>\n\u003cp>The legal implications are even less clear in these circumstances now that Roe v. Wade is overturned.\u003c/p>\n\u003cp>That's why Dr. White says that people who are planning to get pregnant should have conversations with their doctors about what might happen if there is a reason to terminate the pregnancy.\u003c/p>\n\u003cp>\"I would tell people who are pregnant, please enjoy your pregnancy, but don't do it by yourself,\" Dr. White says. She implores people to seek care for their pregnancy early – it's the best way to monitor the health of the parent and baby, and detect complications early.\u003c/p>\n\u003cp>\"It is more important than ever to have a good sense of what it is that you want in terms of pregnancy,\" Dr. White says. \"Find a doctor or a midwife or a clinical person who you can partner with, who you feel comfortable being open and honest with about everything and ... who will be open and honest with you about what's going to be possible.\"\u003c/p>\n\u003cp>Whatever your options, there are people who are willing to help. \"There are legions of doctors and health care professionals who are getting ready for what is happening,\" says Dr. White. \"We are going to be working really hard to put systems in place that everybody can still get the care that they need.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003chr>\n\u003cp>\u003cem>Listen to Life Kit on \u003c/em>\u003ca href=\"http://n.pr/3LdRb0X\">\u003cem>Apple Podcasts\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://n.pr/3K3xVln\">\u003cem>Spotify\u003c/em>\u003c/a>, or sign up for our \u003ca href=\"http://n.pr/3xN1tB9\">newsletter\u003c/a>.\u003c/p>\n\u003cp>\u003cem>The audio portion of this episode was produced by Mansee Khurana. We'd love to hear from you! Email us at or send a voice note to LifeKit@npr.org.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit \u003ca href=\"http://npr.org/\">NPR.org\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+to+consider+about+contraception+and+pregnancy+after+Roe+v.+Wade+is+overturned&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"For decades, the Supreme Court's Roe v. Wade decision protected abortion access and reproductive health decisions. Now, that has been overturned. Here's what you need to know about birth control, emergency contraception and terminating a pregnancy. ","status":"publish","parent":0,"modified":1656108579,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1354},"headData":{"title":"What to Consider About Contraception and Pregnancy After Roe v. Wade Is Overturned | KQED","description":"For decades, the Supreme Court's Roe v. Wade decision protected abortion access and reproductive health decisions. Now, that has been overturned. Here's what you need to know about birth control, emergency contraception and terminating a pregnancy. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11917866 https://ww2.kqed.org/news/?p=11917866","disqusUrl":"https://ww2.kqed.org/news/2022/06/24/what-to-consider-about-contraception-and-pregnancy-after-roe-v-wade-is-overturned/","disqusTitle":"What to Consider About Contraception and Pregnancy After Roe v. Wade Is Overturned","source":"NPR","nprImageCredit":"Catherine McQueen","nprByline":"Mansee Khurana","nprImageAgency":"Getty Images","nprStoryId":"1103677559","nprApiLink":"http://api.npr.org/query?id=1103677559&profileTypeId=15&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/2022/06/08/1103677559/abortion-and-reproductive-health-after-roe?ft=nprml&f=1103677559","nprRetrievedStory":"1","nprPubDate":"Fri, 24 Jun 2022 13:13:00 -0400","nprStoryDate":"Thu, 09 Jun 2022 00:10:54 -0400","nprLastModifiedDate":"Fri, 24 Jun 2022 13:13:25 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/lifekit/2022/06/20220609_lifekit_life_kit_-_life_after_roe__-_update_final.mp3?orgId=1&topicId=1128&aggIds=676529561&d=1509&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559,https://ondemand.npr.org/anon.npr-mp3/npr/lifekit/2022/06/20220609_lifekit_life_kit_-_life_after_roe__-_update_final_noad.mp3?orgId=1&topicId=1128&aggIds=676529561&d=1507&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559","nprAudioM3u":"http://api.npr.org/m3u/11103856335-e18bdd.m3u?orgId=1&topicId=1128&aggIds=676529561&d=1509&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559,http://api.npr.org/m3u/11103860411-5c92c7.m3u?orgId=1&topicId=1128&aggIds=676529561&d=1507&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","path":"/news/11917866/what-to-consider-about-contraception-and-pregnancy-after-roe-v-wade-is-overturned","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/lifekit/2022/06/20220609_lifekit_life_kit_-_life_after_roe__-_update_final.mp3?orgId=1&topicId=1128&aggIds=676529561&d=1509&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559,https://ondemand.npr.org/anon.npr-mp3/npr/lifekit/2022/06/20220609_lifekit_life_kit_-_life_after_roe__-_update_final_noad.mp3?orgId=1&topicId=1128&aggIds=676529561&d=1507&p=510338&story=1103677559&t=podcast&e=1103677559&ft=nprml&f=1103677559","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Access to a safe abortion already varies depending on what state you live in. Now that the Supreme Court has overturned Roe V. Wade, the landmark Supreme Court decision that's protected abortion rights since 1973, the \u003ca href=\"https://www.npr.org/2022/05/04/1096719943/some-states-will-ban-abortion-others-will-expand-access-if-roe-v-wade-is-overtur\">options will become even more limited – or virtually non-existent – in many states\u003c/a>.\u003c/p>\n\u003cp>There are potential implications for reproductive health well beyond abortion – including types of birth control, fertility treatments and treatments during pregnancy. Many people may have to rethink – or think more intentionally about – decisions they've long taken for granted.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11917111","hero":"https://ww2.kqed.org/app/uploads/sites/10/2022/06/RS55728_073_KQED_AbortionRallySF_05032022-qut-1-1020x679.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Here's what you need to know about birth control, emergency contraception and terminating a pregnancy.\u003c/p>\n\u003ch2>Consider \"layering\" contraceptive methods\u003c/h2>\n\u003cp>\u003ca href=\"https://www.cdc.gov/reproductivehealth/contraception/index.htm#Contraceptive-Effectiveness\">Different types of birth control have different rates of failure\u003c/a> – meaning, contraception does not 100% guarantee that you won't get pregnant if you're having sex. Your choice of birth control might depend on the associated side effects, whether your healthcare provider or local pharmacy keeps it in stock, if you have insurance, what your insurance covers and a method's efficacy.\u003c/p>\n\u003cp>Once you decide \u003ca href=\"https://www.npr.org/2020/02/19/807328672/trying-to-decide-what-birth-control-to-use-heres-how-to-make-the-decision\">what type of birth control works for you\u003c/a>, consider whether you need to take extra precautions if you don't want to get pregnant.\u003c/p>\n\u003cp>Dr. Katharine White, \u003ca href=\"https://www.drkatewhite.com/yoursexualhealth/\">an associate professor at Boston University's school of medicine and author of the book \u003cem>Your Sexual Health\u003c/em>\u003c/a> recommends \"layering\" certain methods: if condoms are your primary method of birth control, consider also using the withdrawal method and/or tracking your ovulation so that you know when you're most fertile.\u003c/p>\n\u003cp>\"I call this the BLT approach because it involves stacking methods on top of each other,\" like a bacon-lettuce-tomato sandwich. \"Together, these can be very highly effective,\" says Dr. White.\u003c/p>\n\u003cp>Any birth control, Dr. White says, will be \"much more effective than crossing your fingers hoping that you don't get pregnant.\"\u003c/p>\n\u003ch2>You can keep emergency contraception on hand in case you need it\u003c/h2>\n\u003cp>If your primary birth control fails or if you have unprotected sex and want to prevent pregnancy, you may find yourself at the pharmacy for emergency contraception.\u003c/p>\n\u003cp>Plan B and other emergency contraceptive pills are\u003cstrong> not the same\u003c/strong> as an abortion pill – \u003ca href=\"https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/access-to-emergency-contraception\">emergency contraception prevents someone from getting pregnant in the first place\u003c/a>.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11913295","hero":"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS55729_078_KQED_AbortionRallySF_05032022-qut-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Plan B is one of the most popular brands, but you can find a number of over-the-counter emergency contraceptives with levonorgestrel. You can also ask your provider to prescribe you Ella, an emergency contraceptive pill with ulipristal acetate.\u003c/p>\n\u003cp>\u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/emergency-contraception\">Emergency contraception can prevent more than 95% of pregnancies\u003c/a> when taken within three to five days of unprotected sex. But the sooner you take it, the more effective it is. Many sexually active people keep some on hand in their medicine cabinet as a precautionary measure.\u003c/p>\n\u003cp>Check the expiration date – it's typically several years out, but the pill becomes less effective after it expires. Because of the long shelf-life, you can stock up responsibly in case supplies get short.\u003c/p>\n\u003cp>If you find yourself using emergency contraceptives frequently, consider a different primary method of birth control.\u003c/p>\n\u003cp>\"If someone finds that they're needing to take it often ... [like] more than once in a month or in one menstrual cycle, it may not be as effective because the way it works is to delay ovulation,\" says \u003ca href=\"https://powertodecide.org/\">Dr. Raegan McDonald-Mosley, a practicing OBGYN and the CEO of Power to Decide\u003c/a>, a sexual health and planning nonprofit group.\u003c/p>\n\u003ch2>If you have an unplanned pregnancy, online resources can help find the right option for you\u003c/h2>\n\u003cp>If a home pregnancy test shows that you're pregnant, trust it – \u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940\">it's rare to get a false-positive\u003c/a>. If you're faced with an unwanted pregnancy, most states require you to act quickly.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11917541","hero":"https://ww2.kqed.org/app/uploads/sites/10/2022/06/Lee-Mitchell_IMG_0090-2-1020x728.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>If you live in a state that has severely restricted or eliminated access to abortion, \u003ca href=\"https://www.abortionfinder.org/\">you can find your nearest clinic through Power To Decide's abortion finder\u003c/a>. Going to a clinic that provides abortions does not necessarily mean you will have an abortion, Dr. McDonald-Mosley says. You can make an appointment to confirm a pregnancy and discuss your options with a professional, including information about childcare services.\u003c/p>\n\u003cp>For a lot of people, traveling out of state to an abortion clinic is prohibitively expensive. The \u003ca href=\"https://wrrap.org/\">Women's Reproductive Rights Assistance Project (WRRAP)\u003c/a> or the \u003ca href=\"https://www.ineedana.com/about\">I Need a Database\u003c/a> can show you clinics in your area and link you to local organizations that can help with funding.\u003c/p>\n\u003cp>If you can't travel to a clinic or prefer to manage your own abortion, \u003ca href=\"https://aidaccess.org/en/\">you can get care online through aidaccess.org\u003c/a>. The site provides online consultations for abortions and medication from overseas.\u003c/p>\n\u003cp>\"Those pills are the exact same medication as we provide in our clinic,\" says Robin Marty, the operations director at the \u003ca href=\"https://alabortionclinic.com/\">West Alabama Women's Center\u003c/a>. Like with any medication, there can be health risks with getting medication online – and Marty cautions that \u003ca href=\"https://www.reprolegalhelpline.org/self-managed-abortion-and-the-law/\">depending on where you live, there may be legal repercussions\u003c/a> involved in seeking abortion pills or inducing an abortion at home.\u003c/p>\n\u003cp>Be sure to look up your state's laws about managing your own abortion before you make your decision. There are \u003ca href=\"https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html\">numerous resources online\u003c/a> that explain each state's laws \u003ca href=\"https://www.plannedparenthoodaction.org/abortion-access-tool/CO\">regarding abortion restrictions there\u003c/a>.\u003c/p>\n\u003cp>Seek professional medical care from a local clinic, your doctor or a local urgent care if you experience prolonged bleeding or other complications after taking medication to manage an abortion.\u003c/p>\n\u003cp>Complications from a medical abortion look very much like a miscarriage, says Dr. McDonald-Mosley. \"So someone can potentially present to an emergency room or to their provider and say, 'I'm having cramping and bleeding and I had a positive pregnancy test,' and receive the care that they need without having to reveal that they have taken abortion medications.\"\u003c/p>\n\u003ch2>If you're planning to get pregnant, talk to your provider early about your options, in case of complications\u003c/h2>\n\u003cp>Sometimes, even planned pregnancies end in abortion due to complications that can pose a risk to the pregnant person, or a fetal anomaly that will result in the baby's death.\u003c/p>\n\u003cp>The legal implications are even less clear in these circumstances now that Roe v. Wade is overturned.\u003c/p>\n\u003cp>That's why Dr. White says that people who are planning to get pregnant should have conversations with their doctors about what might happen if there is a reason to terminate the pregnancy.\u003c/p>\n\u003cp>\"I would tell people who are pregnant, please enjoy your pregnancy, but don't do it by yourself,\" Dr. White says. She implores people to seek care for their pregnancy early – it's the best way to monitor the health of the parent and baby, and detect complications early.\u003c/p>\n\u003cp>\"It is more important than ever to have a good sense of what it is that you want in terms of pregnancy,\" Dr. White says. \"Find a doctor or a midwife or a clinical person who you can partner with, who you feel comfortable being open and honest with about everything and ... who will be open and honest with you about what's going to be possible.\"\u003c/p>\n\u003cp>Whatever your options, there are people who are willing to help. \"There are legions of doctors and health care professionals who are getting ready for what is happening,\" says Dr. White. \"We are going to be working really hard to put systems in place that everybody can still get the care that they need.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003chr>\n\u003cp>\u003cem>Listen to Life Kit on \u003c/em>\u003ca href=\"http://n.pr/3LdRb0X\">\u003cem>Apple Podcasts\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://n.pr/3K3xVln\">\u003cem>Spotify\u003c/em>\u003c/a>, or sign up for our \u003ca href=\"http://n.pr/3xN1tB9\">newsletter\u003c/a>.\u003c/p>\n\u003cp>\u003cem>The audio portion of this episode was produced by Mansee Khurana. We'd love to hear from you! Email us at or send a voice note to LifeKit@npr.org.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit \u003ca href=\"http://npr.org/\">NPR.org\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+to+consider+about+contraception+and+pregnancy+after+Roe+v.+Wade+is+overturned&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11917866/what-to-consider-about-contraception-and-pregnancy-after-roe-v-wade-is-overturned","authors":["byline_news_11917866"],"categories":["news_8"],"tags":["news_866","news_19985","news_31256","news_18077"],"affiliates":["news_253"],"featImg":"news_11917867","label":"source_news_11917866"},"news_11916973":{"type":"posts","id":"news_11916973","meta":{"index":"posts_1591205157","site":"news","id":"11916973","score":null,"sort":[1655145829000]},"guestAuthors":[],"slug":"its-not-just-you-tampons-are-harder-to-find-and-pricier","title":"It's Not Just You: Tampons Are Harder To Find — And Pricier","publishDate":1655145829,"format":"standard","headTitle":"NPR | KQED News","labelTerm":{"term":253,"site":"news"},"content":"\u003cp>People who menstruate are saying it's hard to find tampons on store shelves across the U.S. right now, as supply chain upsets reach the feminine care aisle.\u003c/p>\n\u003cp>\"I just went to 5 different Walgreens [and] the shelves are CLEARED,\" \u003ca href=\"https://twitter.com/lilhandsy/status/1534618564547575808?s=20&t=gVLj5V6-npWQdBYy81iTgw%20\">said one Twitter user this past week\u003c/a>, while \u003ca href=\"https://www.reddit.com/r/TwoXChromosomes/comments/u4nwmj/the_great_tampon_shortage_of_current_day/\">people on Reddit have posted about empty shelves going back months.\u003c/a>\u003c/p>\n\u003cp>The shortage stems from a combination of factory staffing challenges, transportation bottlenecks, and the rising costs of key raw materials used to make the products, tampon makers say.\u003c/p>\n\u003cp>CVS, Target and Walgreens said in statements to NPR that they were aware of a limited tampon supply at some stores. A spokesperson for CVS said that, in recent weeks, suppliers haven't been able to fulfill the full orders placed by the company. Both companies said they're working with tampon makers to replenish store inventory as soon as possible.\u003c/p>\n\u003cp>Walgreens said its shortages \"may only be in specific brands while we navigate the supply disruption,\" but that its website is updated with the latest store-level inventory.\u003c/p>\n\u003cp>Dana Marlowe, the founder of I Support the Girls, an organization that provides menstrual products for people with economic hardship, says the shortage has been happening for longer than most people realize.\u003c/p>\n\u003cp>Marlowe says her group has seen a large drop in tampon donations in recent months. The organization received half as many tampons this year compared to the same time last year and over 60% less than in 2020.\u003c/p>\n\u003cp>\"Our shelves our bare,\" Marlowe told NPR.\u003c/p>\n\u003cp>Procter & Gamble, makers of Tampax products, told NPR the supply problem is temporary and that \"the Tampax team is producing tampons 24/7 to meet the increased demand.\"\u003c/p>\n\u003cp>P&G, which owns the biggest market share of menstrual products, said in an April earnings call that sourcing and transporting raw materials for menstrual products, as well as getting products on trucks to retailers, \"continues to be costly and highly volatile.\"\u003c/p>\n\u003ch3>It's another supply chain issue affecting women\u003c/h3>\n\u003cp>It's another supply chain problem where women are bearing the brunt of the cost, as \u003ca href=\"https://www.npr.org/2022/05/19/1099748064/baby-infant-formula-shortages\">mothers struggle to feed their babies during the baby formula shortage\u003c/a>.\u003c/p>\n\u003cp>\u003cem>Time\u003c/em> \u003ca href=\"https://time.com./6184644/tampon-shortage-supply-chain/\">first reported on the tampon shortage\u003c/a> last week, noting that it's lasted longer than other shortages, like toilet paper and cleaning supplies, early on in the pandemic. Decision-makers in the supply chain and CEOs of manufacturers are mostly men, the magazine reported.\u003c/p>\n\u003cp>Tampons are also getting more expensive due to inflation. A year after announcing increased prices on feminine care products, P&G said in the April earnings call that ongoing supply chain constraints led to another price hike on the products, which will go into effect in mid-July.\u003c/p>\n\u003cp>\u003ca href=\"https://www.bloomberg.com/news/articles/2022-06-09/inflation-is-pushing-tampon-prices-up-10\">The average price for tampons rose by nearly 10% in the year through last month\u003c/a>, Bloomberg reported citing NielsenIQ data, because of rising costs of the materials used. The materials that make up tampons, including cotton, rayon, fluff pulp and plastic, have been in high demand for use in masks and other medical products during the pandemic. Extreme drought in Texas, diesel prices and Russia's invasion of Ukraine also tightened the supply of those goods.\u003c/p>\n\u003cp>I Support The Girls founder Marlowe said that existing stigmas and taboos around menstruation make it difficult to garner national attention and action needed to solve the scarcity problem. It's one that affects vulnerable groups the most, she said.\u003c/p>\n\u003cp>She's met women who don't have the resources to make multiple trips to the store, she said, and have resorted to unsafe methods. \"They're using cardboard and duct tape, ripped up sheets,\" and other unsanitary items, she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=It%27s+not+just+you%3A+Tampons+are+harder+to+find+%E2%80%94+and+pricier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Many women say store shelves that once had the menstrual essentials have been sparse for months. When they are available, tampons have been a lot more expensive recently, due in part to inflation.","status":"publish","parent":0,"modified":1655236423,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":625},"headData":{"title":"It's Not Just You: Tampons Are Harder To Find — And Pricier | KQED","description":"Many women say store shelves that once had the menstrual essentials have been sparse for months. When they are available, tampons have been a lot more expensive recently, due in part to inflation.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11916973 https://ww2.kqed.org/news/?p=11916973","disqusUrl":"https://ww2.kqed.org/news/2022/06/13/its-not-just-you-tampons-are-harder-to-find-and-pricier/","disqusTitle":"It's Not Just You: Tampons Are Harder To Find — And Pricier","nprByline":"Emma Bowman","nprImageAgency":"Dana Marlowe","nprStoryId":"1104393549","nprApiLink":"http://api.npr.org/query?id=1104393549&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/2022/06/12/1104393549/tampons-are-the-latest-supply-chain-casualty-women-took-notice-months-ago?ft=nprml&f=1104393549","nprRetrievedStory":"1","nprPubDate":"Sun, 12 Jun 2022 17:44:00 -0400","nprStoryDate":"Sun, 12 Jun 2022 15:11:34 -0400","nprLastModifiedDate":"Sun, 12 Jun 2022 17:44:48 -0400","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","path":"/news/11916973/its-not-just-you-tampons-are-harder-to-find-and-pricier","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>People who menstruate are saying it's hard to find tampons on store shelves across the U.S. right now, as supply chain upsets reach the feminine care aisle.\u003c/p>\n\u003cp>\"I just went to 5 different Walgreens [and] the shelves are CLEARED,\" \u003ca href=\"https://twitter.com/lilhandsy/status/1534618564547575808?s=20&t=gVLj5V6-npWQdBYy81iTgw%20\">said one Twitter user this past week\u003c/a>, while \u003ca href=\"https://www.reddit.com/r/TwoXChromosomes/comments/u4nwmj/the_great_tampon_shortage_of_current_day/\">people on Reddit have posted about empty shelves going back months.\u003c/a>\u003c/p>\n\u003cp>The shortage stems from a combination of factory staffing challenges, transportation bottlenecks, and the rising costs of key raw materials used to make the products, tampon makers say.\u003c/p>\n\u003cp>CVS, Target and Walgreens said in statements to NPR that they were aware of a limited tampon supply at some stores. A spokesperson for CVS said that, in recent weeks, suppliers haven't been able to fulfill the full orders placed by the company. Both companies said they're working with tampon makers to replenish store inventory as soon as possible.\u003c/p>\n\u003cp>Walgreens said its shortages \"may only be in specific brands while we navigate the supply disruption,\" but that its website is updated with the latest store-level inventory.\u003c/p>\n\u003cp>Dana Marlowe, the founder of I Support the Girls, an organization that provides menstrual products for people with economic hardship, says the shortage has been happening for longer than most people realize.\u003c/p>\n\u003cp>Marlowe says her group has seen a large drop in tampon donations in recent months. The organization received half as many tampons this year compared to the same time last year and over 60% less than in 2020.\u003c/p>\n\u003cp>\"Our shelves our bare,\" Marlowe told NPR.\u003c/p>\n\u003cp>Procter & Gamble, makers of Tampax products, told NPR the supply problem is temporary and that \"the Tampax team is producing tampons 24/7 to meet the increased demand.\"\u003c/p>\n\u003cp>P&G, which owns the biggest market share of menstrual products, said in an April earnings call that sourcing and transporting raw materials for menstrual products, as well as getting products on trucks to retailers, \"continues to be costly and highly volatile.\"\u003c/p>\n\u003ch3>It's another supply chain issue affecting women\u003c/h3>\n\u003cp>It's another supply chain problem where women are bearing the brunt of the cost, as \u003ca href=\"https://www.npr.org/2022/05/19/1099748064/baby-infant-formula-shortages\">mothers struggle to feed their babies during the baby formula shortage\u003c/a>.\u003c/p>\n\u003cp>\u003cem>Time\u003c/em> \u003ca href=\"https://time.com./6184644/tampon-shortage-supply-chain/\">first reported on the tampon shortage\u003c/a> last week, noting that it's lasted longer than other shortages, like toilet paper and cleaning supplies, early on in the pandemic. Decision-makers in the supply chain and CEOs of manufacturers are mostly men, the magazine reported.\u003c/p>\n\u003cp>Tampons are also getting more expensive due to inflation. A year after announcing increased prices on feminine care products, P&G said in the April earnings call that ongoing supply chain constraints led to another price hike on the products, which will go into effect in mid-July.\u003c/p>\n\u003cp>\u003ca href=\"https://www.bloomberg.com/news/articles/2022-06-09/inflation-is-pushing-tampon-prices-up-10\">The average price for tampons rose by nearly 10% in the year through last month\u003c/a>, Bloomberg reported citing NielsenIQ data, because of rising costs of the materials used. The materials that make up tampons, including cotton, rayon, fluff pulp and plastic, have been in high demand for use in masks and other medical products during the pandemic. Extreme drought in Texas, diesel prices and Russia's invasion of Ukraine also tightened the supply of those goods.\u003c/p>\n\u003cp>I Support The Girls founder Marlowe said that existing stigmas and taboos around menstruation make it difficult to garner national attention and action needed to solve the scarcity problem. It's one that affects vulnerable groups the most, she said.\u003c/p>\n\u003cp>She's met women who don't have the resources to make multiple trips to the store, she said, and have resorted to unsafe methods. \"They're using cardboard and duct tape, ripped up sheets,\" and other unsanitary items, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=It%27s+not+just+you%3A+Tampons+are+harder+to+find+%E2%80%94+and+pricier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11916973/its-not-just-you-tampons-are-harder-to-find-and-pricier","authors":["byline_news_11916973"],"categories":["news_8"],"tags":["news_18077"],"affiliates":["news_253"],"featImg":"news_11916974","label":"news_253"},"news_11744167":{"type":"posts","id":"news_11744167","meta":{"index":"posts_1591205157","site":"news","id":"11744167","score":null,"sort":[1556735988000]},"guestAuthors":[],"slug":"period-poverty-raising-awareness-about-an-overlooked-global-issue","title":"Period Poverty: Raising Awareness About An Overlooked Global Issue","publishDate":1556735988,"format":"audio","headTitle":"KQED News","labelTerm":{},"content":"\u003cp>\u003cem>The following story was produced for \u003ca href=\"https://www.kqed.org/news/tag/youth-takeover\" target=\"_blank\" rel=\"noopener\">Youth Takeover\u003c/a> week at KQED.\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_11744190\" class=\"wp-caption alignright\" style=\"max-width: 283px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Copy-of-Genevieve-Schweitzer-e1556735157404.jpg\">\u003cimg class=\" wp-image-11744190\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Copy-of-Genevieve-Schweitzer-e1556735157404.jpg\" alt=\"\" width=\"283\" height=\"359\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Genevieve Schweitzer is a 10th-grader at El Cerrito High School.\u003c/figcaption>\u003c/figure>\n\u003cp>When I was a young girl, I started donating general hygiene products to a women’s shelter in Berkeley. I would drop off things like soap, lotion and toothbrushes. But it never really crossed my mind that women in shelters might be in need of menstrual products too.\u003c/p>\n\u003cp>That changed when I started a feminist club with my friend at our high school. As I began to spend more time learning about relevant feminist issues, I found out about the real but rarely addressed issue of period poverty, in which poor women lack access to menstrual products.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.slu.edu/news/2019/january/menstrual-products-access-research.php\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a> conducted by St. Louis University found that nearly two-thirds of low-income women in that city over the last year couldn’t afford menstrual hygiene products like tampons or pads. Respondents said they instead sometimes resorted to using cloth, rags, tissues, toilet paper and sometimes even diapers or paper towels from public bathrooms. Nearly half the women in the survey also said that there were times in the past year when they couldn’t afford both food and period products.\u003c/p>\n\u003cp>“I do know of women who have talked about using toilet tissue paper or paper towels,” said Wanda Johnson, a nurse practitioner at Alameda County Health Care for the Homeless. “One woman, she was telling me that she had a sock and she wrapped the paper towel around the sock because that was the best way to wick it away.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nadya Okamoto, a Harvard University student on leave, started the organization \u003ca href=\"https://www.period.org/\" target=\"_blank\" rel=\"noopener\">PERIOD: The Menstrual Movement\u003c/a> when she was 16 to raise greater awareness about this issue.\u003c/p>\n\u003cp>“People don't talk about it and it's not really something that people know about or think about beyond their own experiences with it,” she said.\u003c/p>\n\u003cp>Women feel ashamed asking for products because of this unspoken rule that they shouldn’t talk about their periods with other people, Okamoto explained.\u003c/p>\n\u003cp>[aside label=\"More Youth Takeover stories\" tag=\"youth-takeover\"]\u003c/p>\n\u003cp>“A big barrier, too, is that food stamps don't cover period products as necessities,” Okamoto said. “So a lot of the time it makes it even less affordable for people who really can't afford those necessities.”\u003c/p>\n\u003cp>Period products are \u003ca href=\"https://www.npr.org/sections/money/2019/03/06/700876425/tampons-that-bloody-sales-tax\" target=\"_blank\" rel=\"noopener\">currently taxed in 35 states\u003c/a> in the country, including California, which makes them even less affordable for people with limited incomes. Meanwhile, items that are considered basic necessities, like most food products and sunscreen, are often tax exempt.\u003c/p>\n\u003cp>Wanda Johnson’s experience has taught her that the medical field doesn’t adequately address the issue of menstrual hygiene, but notes that she’s noticed some positive changes.\u003c/p>\n\u003cp>“We offer hygiene kits,” she said, adding that she has seen a growing number of shelters starting to offer period products to women in need, including one that recently placed a basket of products in its bathroom.\u003c/p>\n\u003cp>Meanwhile, an increasing number of states are considering abolishing taxes on menstrual products, \u003ca href=\"https://www.sfchronicle.com/politics/article/Repealing-California-s-tampon-tax-Gender-13707290.php\" target=\"_blank\" rel=\"noopener\">including California\u003c/a>, where a bill to repeal the tax is being taken up in the state Legislature. Most recently, \u003ca href=\"https://www.vox.com/2018/11/7/18056648/nevada-question-2-tampon-tax-results\" target=\"_blank\" rel=\"noopener\">Nevada voters\u003c/a> in 2018 approved scrapping the “tampon tax,” making it the 10th state in the country to do so (five other states don’t have any sales taxes). And \u003ca href=\"https://www.bloomberg.com/graphics/2018-tampon-cost/\" target=\"_blank\" rel=\"noopener\">a growing list of countries\u003c/a> around the world, including Canada, India, Kenya and Ireland, have eliminated these taxes altogether.\u003c/p>\n\u003cp>These developments are a sure sign that women are making their voices heard and driving home the message that period poverty is a human rights issue. Period.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Genevieve Schweizer is a 10th-grader at El Cerrito High School.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Many low-income women can't afford menstrual products and must resort to using uncomfortable, unhealthy alternatives.","status":"publish","parent":0,"modified":1556921407,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":636},"headData":{"title":"Period Poverty: Raising Awareness About An Overlooked Global Issue | KQED","description":"Many low-income women can't afford menstrual products and must resort to using uncomfortable, unhealthy alternatives.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11744167 https://ww2.kqed.org/news/?p=11744167","disqusUrl":"https://ww2.kqed.org/news/2019/05/01/period-poverty-raising-awareness-about-an-overlooked-global-issue/","disqusTitle":"Period Poverty: Raising Awareness About An Overlooked Global Issue","source":"Youth Takeover","sourceUrl":"https://www.kqed.org/news/tag/youth-takeover","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2019/04/YTOPeriodPoverty.mp3","nprByline":"Genevieve Schweitzer","audioTrackLength":244,"path":"/news/11744167/period-poverty-raising-awareness-about-an-overlooked-global-issue","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>The following story was produced for \u003ca href=\"https://www.kqed.org/news/tag/youth-takeover\" target=\"_blank\" rel=\"noopener\">Youth Takeover\u003c/a> week at KQED.\u003c/em>\u003c/p>\n\u003cfigure id=\"attachment_11744190\" class=\"wp-caption alignright\" style=\"max-width: 283px\">\u003ca href=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Copy-of-Genevieve-Schweitzer-e1556735157404.jpg\">\u003cimg class=\" wp-image-11744190\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/05/Copy-of-Genevieve-Schweitzer-e1556735157404.jpg\" alt=\"\" width=\"283\" height=\"359\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Genevieve Schweitzer is a 10th-grader at El Cerrito High School.\u003c/figcaption>\u003c/figure>\n\u003cp>When I was a young girl, I started donating general hygiene products to a women’s shelter in Berkeley. I would drop off things like soap, lotion and toothbrushes. But it never really crossed my mind that women in shelters might be in need of menstrual products too.\u003c/p>\n\u003cp>That changed when I started a feminist club with my friend at our high school. As I began to spend more time learning about relevant feminist issues, I found out about the real but rarely addressed issue of period poverty, in which poor women lack access to menstrual products.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.slu.edu/news/2019/january/menstrual-products-access-research.php\" target=\"_blank\" rel=\"noopener\">recent survey\u003c/a> conducted by St. Louis University found that nearly two-thirds of low-income women in that city over the last year couldn’t afford menstrual hygiene products like tampons or pads. Respondents said they instead sometimes resorted to using cloth, rags, tissues, toilet paper and sometimes even diapers or paper towels from public bathrooms. Nearly half the women in the survey also said that there were times in the past year when they couldn’t afford both food and period products.\u003c/p>\n\u003cp>“I do know of women who have talked about using toilet tissue paper or paper towels,” said Wanda Johnson, a nurse practitioner at Alameda County Health Care for the Homeless. “One woman, she was telling me that she had a sock and she wrapped the paper towel around the sock because that was the best way to wick it away.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nadya Okamoto, a Harvard University student on leave, started the organization \u003ca href=\"https://www.period.org/\" target=\"_blank\" rel=\"noopener\">PERIOD: The Menstrual Movement\u003c/a> when she was 16 to raise greater awareness about this issue.\u003c/p>\n\u003cp>“People don't talk about it and it's not really something that people know about or think about beyond their own experiences with it,” she said.\u003c/p>\n\u003cp>Women feel ashamed asking for products because of this unspoken rule that they shouldn’t talk about their periods with other people, Okamoto explained.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Youth Takeover stories ","tag":"youth-takeover"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“A big barrier, too, is that food stamps don't cover period products as necessities,” Okamoto said. “So a lot of the time it makes it even less affordable for people who really can't afford those necessities.”\u003c/p>\n\u003cp>Period products are \u003ca href=\"https://www.npr.org/sections/money/2019/03/06/700876425/tampons-that-bloody-sales-tax\" target=\"_blank\" rel=\"noopener\">currently taxed in 35 states\u003c/a> in the country, including California, which makes them even less affordable for people with limited incomes. Meanwhile, items that are considered basic necessities, like most food products and sunscreen, are often tax exempt.\u003c/p>\n\u003cp>Wanda Johnson’s experience has taught her that the medical field doesn’t adequately address the issue of menstrual hygiene, but notes that she’s noticed some positive changes.\u003c/p>\n\u003cp>“We offer hygiene kits,” she said, adding that she has seen a growing number of shelters starting to offer period products to women in need, including one that recently placed a basket of products in its bathroom.\u003c/p>\n\u003cp>Meanwhile, an increasing number of states are considering abolishing taxes on menstrual products, \u003ca href=\"https://www.sfchronicle.com/politics/article/Repealing-California-s-tampon-tax-Gender-13707290.php\" target=\"_blank\" rel=\"noopener\">including California\u003c/a>, where a bill to repeal the tax is being taken up in the state Legislature. Most recently, \u003ca href=\"https://www.vox.com/2018/11/7/18056648/nevada-question-2-tampon-tax-results\" target=\"_blank\" rel=\"noopener\">Nevada voters\u003c/a> in 2018 approved scrapping the “tampon tax,” making it the 10th state in the country to do so (five other states don’t have any sales taxes). And \u003ca href=\"https://www.bloomberg.com/graphics/2018-tampon-cost/\" target=\"_blank\" rel=\"noopener\">a growing list of countries\u003c/a> around the world, including Canada, India, Kenya and Ireland, have eliminated these taxes altogether.\u003c/p>\n\u003cp>These developments are a sure sign that women are making their voices heard and driving home the message that period poverty is a human rights issue. Period.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Genevieve Schweizer is a 10th-grader at El Cerrito High School.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11744167/period-poverty-raising-awareness-about-an-overlooked-global-issue","authors":["byline_news_11744167"],"categories":["news_18540","news_457","news_8"],"tags":["news_25391","news_22836","news_18077","news_23013"],"featImg":"news_11744189","label":"source_news_11744167"},"stateofhealth_242164":{"type":"posts","id":"stateofhealth_242164","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"242164","score":null,"sort":[1475001033000]},"guestAuthors":[],"slug":"california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","title":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control","publishDate":1475001033,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California women will only have to make one trip a year to the pharmacy to pick up birth control under a new law.\u003c/p>\n\u003cp>Gov. Jerry Brown recently signed a bill to allow pharmacists to dispense 12 months of hormonal contraceptives at one time. This will make it more convenient for women in the state, who previously, were only able to get a three months supply at a time.\u003c/p>\n\u003cp>The new law will also requires insurance companies to cover a year's supply of doctor-prescribed birth control.\u003c/p>\n\u003cp>The bill's author, Democratic Sen. Fran Pavley of Agoura Hills, and other supporters, said longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.\u003c/p>\n\u003cp>“Given the demands of work and family, women can’t always find time to run off to a drug store to refill an ongoing prescription,” Pavley said in a written statement. “Unlike with other medications, to go even a day or two without birth control can result in a serious consequence. This change will make women’s lives easier and dramatically reduce the risk of unintended pregnancy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A University of California San Francisco \u003ca href=\"https://bixbycenter.ucsf.edu/news/making-one-year-supply-birth-control-national-standard\" target=\"_blank\">study\u003c/a> found that a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in passing laws allowing for access to a year's supply of birth control.\u003c/p>\n\u003cp>Health insurance associations had opposed the change, claiming it could result in duplicate coverage by different insurers and more wasted medication.\u003c/p>\n\u003cp>The new law will take effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Supporters say longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.","status":"publish","parent":0,"modified":1475001295,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":305},"headData":{"title":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control | KQED","description":"Supporters say longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"242164 http://ww2.kqed.org/stateofhealth/?p=242164","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/27/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once/","disqusTitle":"California Women Will Soon Be Able to Get a Year's Supply of Birth Control","path":"/stateofhealth/242164/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California women will only have to make one trip a year to the pharmacy to pick up birth control under a new law.\u003c/p>\n\u003cp>Gov. Jerry Brown recently signed a bill to allow pharmacists to dispense 12 months of hormonal contraceptives at one time. This will make it more convenient for women in the state, who previously, were only able to get a three months supply at a time.\u003c/p>\n\u003cp>The new law will also requires insurance companies to cover a year's supply of doctor-prescribed birth control.\u003c/p>\n\u003cp>The bill's author, Democratic Sen. Fran Pavley of Agoura Hills, and other supporters, said longer supplies will reduce skipped doses and prevent unintended pregnancies and abortions.\u003c/p>\n\u003cp>“Given the demands of work and family, women can’t always find time to run off to a drug store to refill an ongoing prescription,” Pavley said in a written statement. “Unlike with other medications, to go even a day or two without birth control can result in a serious consequence. This change will make women’s lives easier and dramatically reduce the risk of unintended pregnancy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A University of California San Francisco \u003ca href=\"https://bixbycenter.ucsf.edu/news/making-one-year-supply-birth-control-national-standard\" target=\"_blank\">study\u003c/a> found that a 12-month supply of birth control decreased unplanned pregnancies by 30 percent, compared with a supply of just one or three months. The study also found that giving women a one-year supply of birth control reduced the odds of an abortion by 46 percent.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in passing laws allowing for access to a year's supply of birth control.\u003c/p>\n\u003cp>Health insurance associations had opposed the change, claiming it could result in duplicate coverage by different insurers and more wasted medication.\u003c/p>\n\u003cp>The new law will take effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/242164/california-women-will-soon-be-able-to-get-a-years-supply-of-birth-control-at-once","authors":["11105"],"categories":["stateofhealth_14"],"tags":["stateofhealth_625","stateofhealth_2808","stateofhealth_2942","stateofhealth_2519","stateofhealth_2958"],"featImg":"stateofhealth_242167","label":"stateofhealth"},"news_10966324":{"type":"posts","id":"news_10966324","meta":{"index":"posts_1591205157","site":"news","id":"10966324","score":null,"sort":[1464126797000]},"guestAuthors":[],"slug":"california-washington-sue-johnson-johnson-over-pelvic-mesh-implants","title":"California, Washington Sue Johnson & Johnson Over Pelvic Mesh Implants","publishDate":1464126797,"format":"standard","headTitle":"The California Report | KQED News","labelTerm":{"term":72,"site":"news"},"content":"\u003cp>SEATTLE — Washington state and California sued Johnson & Johnson on Tuesday, saying that for years the company misrepresented the risks of vaginal mesh implants it sold to repair pelvic collapse.\u003c/p>\n\u003cp>In the latest legal actions over the problem-prone devices, Attorneys General Bob Ferguson of Washington and Kamala Harris of California accused the New Jersey-based health care giant of neglecting to tell patients and doctors about the risks and occurrences of dire, sometimes irreversible complications. Those include urinary dysfunction, loss of sexual function, constipation and severe pain.\u003c/p>\n\u003cp>\"For many victims, their health and their quality of life were forever changed as a result of this deception,\" Ferguson told a news conference. \"Sitting upright, lying on their side, walking all became incredibly painful. ... These women were robbed of their ability to live and work in the way they once did.\"\u003c/p>\n\u003cp>Patients have already filed tens of thousands of lawsuits against mesh manufacturers, including New Jersey-based Johnson & Johnson, Massachusetts-based Boston Scientific and Ireland-based Endo International. In 2014, Endo said it would pay $830 million to settle more than 20,000 personal injury lawsuits. Johnson & Johnson faces more than 35,000 lawsuits, Harris said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These women were robbed of their ability to live and work in the way they once did.'\u003c/aside>\n\u003cp>The plastic mesh is used to treat pelvic organ prolapse, a condition that involves organs such as the bladder, bowel and uterus shifting, often after childbirth, a hysterectomy or menopause. In response to thousands of injuries from the mesh, the U.S. Food and Drug Administration early this year re-labeled the products high risk instead of moderate and announced new federal scrutiny for them. The agency had already concluded that women getting vaginal mesh have more complications than women who undergo traditional surgery with stitches.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an emailed statement, Johnson & Johnson subsidiary Ethicon Inc., which marketed the mesh, called the lawsuits unjustified.\u003c/p>\n\u003cp>\"The evidence will show that Ethicon acted appropriately and responsibly in the marketing of our pelvic mesh products,\" the company said. \"The use of implantable mesh is often the preferred option to treat certain female pelvic conditions, including pelvic organ prolapse and stress urinary incontinence, and is backed by years of clinical research.\u003c/p>\n\u003cp>\"Ethicon is concerned that the attorneys general's decision to file its lawsuit will keep women from obtaining treatment for the often-debilitating symptoms of stress urinary incontinence.\"\u003c/p>\n\u003cfigure id=\"attachment_10966337\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/05/Kamala-800x1090.jpg\" alt=\"California Attorney General Kamala Harris joined Washington state in the lawsuit against Johnson & Johnson.\" width=\"800\" height=\"1090\" class=\"size-medium wp-image-10966337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-800x1090.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-400x545.jpg 400w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-1180x1608.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-960x1309.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Attorney General Kamala Harris joined Washington state in the lawsuit against Johnson & Johnson. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California and Washington led a group of 46 states and the District of Columbia in investigating the company's practices. California's lawsuit alleges false advertising and deceptive marketing. In a news release, Harris noted that Johnson & Johnson sold nearly 790,000 of the devices nationwide from 2008 to 2014, including more than 42,000 in California.\u003c/p>\n\u003cp>Washington's lawsuit alleges tens of thousands of violations of the state's consumer protection law and seeks penalties that could reach well into the millions of dollars. Ferguson said Johnson & Johnson sold 12,000 of the devices in Washington, but it never told patients the mesh can cause chronic inflammation as their body rejects the foreign material; that the mesh harbors infections that can live indefinitely in its small weave; or that the mesh frequently protrudes into an organ or through the vaginal wall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He noted a 2009 email that one doctor sent to Johnson & Johnson just before operating on a woman. \"She will likely lose any coital function as her vaginal length is now 3cm, and there is mesh extruding literally everywhere,\" the doctor wrote. \"This patient will have a permanently destroyed vagina.\"\u003c/p>\n\n","blocks":[],"excerpt":"Both states accuse the health care giant of neglecting to tell patients and doctors about the risks of dire, sometimes irreversible complications.","status":"publish","parent":0,"modified":1464127773,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":616},"headData":{"title":"California, Washington Sue Johnson & Johnson Over Pelvic Mesh Implants | KQED","description":"Both states accuse the health care giant of neglecting to tell patients and doctors about the risks of dire, sometimes irreversible complications.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"10966324 http://ww2.kqed.org/news/?p=10966324","disqusUrl":"https://ww2.kqed.org/news/2016/05/24/california-washington-sue-johnson-johnson-over-pelvic-mesh-implants/","disqusTitle":"California, Washington Sue Johnson & Johnson Over Pelvic Mesh Implants","nprByline":"\u003cstrong>Gene Johnson\u003cbr>Associated Press\u003c/strong>","nprStoryId":"479372818","path":"/news/10966324/california-washington-sue-johnson-johnson-over-pelvic-mesh-implants","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>SEATTLE — Washington state and California sued Johnson & Johnson on Tuesday, saying that for years the company misrepresented the risks of vaginal mesh implants it sold to repair pelvic collapse.\u003c/p>\n\u003cp>In the latest legal actions over the problem-prone devices, Attorneys General Bob Ferguson of Washington and Kamala Harris of California accused the New Jersey-based health care giant of neglecting to tell patients and doctors about the risks and occurrences of dire, sometimes irreversible complications. Those include urinary dysfunction, loss of sexual function, constipation and severe pain.\u003c/p>\n\u003cp>\"For many victims, their health and their quality of life were forever changed as a result of this deception,\" Ferguson told a news conference. \"Sitting upright, lying on their side, walking all became incredibly painful. ... These women were robbed of their ability to live and work in the way they once did.\"\u003c/p>\n\u003cp>Patients have already filed tens of thousands of lawsuits against mesh manufacturers, including New Jersey-based Johnson & Johnson, Massachusetts-based Boston Scientific and Ireland-based Endo International. In 2014, Endo said it would pay $830 million to settle more than 20,000 personal injury lawsuits. Johnson & Johnson faces more than 35,000 lawsuits, Harris said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These women were robbed of their ability to live and work in the way they once did.'\u003c/aside>\n\u003cp>The plastic mesh is used to treat pelvic organ prolapse, a condition that involves organs such as the bladder, bowel and uterus shifting, often after childbirth, a hysterectomy or menopause. In response to thousands of injuries from the mesh, the U.S. Food and Drug Administration early this year re-labeled the products high risk instead of moderate and announced new federal scrutiny for them. The agency had already concluded that women getting vaginal mesh have more complications than women who undergo traditional surgery with stitches.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an emailed statement, Johnson & Johnson subsidiary Ethicon Inc., which marketed the mesh, called the lawsuits unjustified.\u003c/p>\n\u003cp>\"The evidence will show that Ethicon acted appropriately and responsibly in the marketing of our pelvic mesh products,\" the company said. \"The use of implantable mesh is often the preferred option to treat certain female pelvic conditions, including pelvic organ prolapse and stress urinary incontinence, and is backed by years of clinical research.\u003c/p>\n\u003cp>\"Ethicon is concerned that the attorneys general's decision to file its lawsuit will keep women from obtaining treatment for the often-debilitating symptoms of stress urinary incontinence.\"\u003c/p>\n\u003cfigure id=\"attachment_10966337\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/05/Kamala-800x1090.jpg\" alt=\"California Attorney General Kamala Harris joined Washington state in the lawsuit against Johnson & Johnson.\" width=\"800\" height=\"1090\" class=\"size-medium wp-image-10966337\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-800x1090.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-400x545.jpg 400w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-1180x1608.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/10/2016/05/Kamala-960x1309.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Attorney General Kamala Harris joined Washington state in the lawsuit against Johnson & Johnson. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California and Washington led a group of 46 states and the District of Columbia in investigating the company's practices. California's lawsuit alleges false advertising and deceptive marketing. In a news release, Harris noted that Johnson & Johnson sold nearly 790,000 of the devices nationwide from 2008 to 2014, including more than 42,000 in California.\u003c/p>\n\u003cp>Washington's lawsuit alleges tens of thousands of violations of the state's consumer protection law and seeks penalties that could reach well into the millions of dollars. Ferguson said Johnson & Johnson sold 12,000 of the devices in Washington, but it never told patients the mesh can cause chronic inflammation as their body rejects the foreign material; that the mesh harbors infections that can live indefinitely in its small weave; or that the mesh frequently protrudes into an organ or through the vaginal wall.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He noted a 2009 email that one doctor sent to Johnson & Johnson just before operating on a woman. \"She will likely lose any coital function as her vaginal length is now 3cm, and there is mesh extruding literally everywhere,\" the doctor wrote. \"This patient will have a permanently destroyed vagina.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/10966324/california-washington-sue-johnson-johnson-over-pelvic-mesh-implants","authors":["byline_news_10966324"],"programs":["news_72"],"categories":["news_457","news_6188","news_8"],"tags":["news_17286","news_18077"],"featImg":"news_10966325","label":"news_72"},"stateofhealth_131770":{"type":"posts","id":"stateofhealth_131770","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"131770","score":null,"sort":[1451429812000]},"guestAuthors":[],"slug":"redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital","title":"Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation","publishDate":1451429812,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman's contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical -- part of Dignity Health -- does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. \"We shouldn't allow religion or any hospital to decide what is best for a patient and her family,\" said Dr. Pratima Gupta, a fellow with the organization. \"It really should be in consultation with her doctor.\"\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/240534476\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company's policy not to comment on pending litigation, but in a statement said that \"the care and safety of our patients is always our top priority.\"\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide \"sterilization services ... in accordance with Ethical and Religious Directives for Catholic Health Care Services ... \" The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health's system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n","blocks":[],"excerpt":"Mercy Medical Center Redding says it does not perform sterilizations in accordance with Catholic directives.","status":"publish","parent":0,"modified":1452038228,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":782},"headData":{"title":"Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation | KQED","description":"Mercy Medical Center Redding says it does not perform sterilizations in accordance with Catholic directives.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"131770 http://ww2.kqed.org/stateofhealth/?p=131770","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/29/redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital/","disqusTitle":"Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation","path":"/stateofhealth/131770/redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman's contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical -- part of Dignity Health -- does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. \"We shouldn't allow religion or any hospital to decide what is best for a patient and her family,\" said Dr. Pratima Gupta, a fellow with the organization. \"It really should be in consultation with her doctor.\"\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/240534476&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/240534476'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company's policy not to comment on pending litigation, but in a statement said that \"the care and safety of our patients is always our top priority.\"\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide \"sterilization services ... in accordance with Ethical and Religious Directives for Catholic Health Care Services ... \" The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health's system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/131770/redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital","authors":["240"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_131796","label":"stateofhealth"},"stateofhealth_25735":{"type":"posts","id":"stateofhealth_25735","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"25735","score":null,"sort":[1431273670000]},"guestAuthors":[],"slug":"how-one-hospital-brought-its-c-section-rate-down-in-a-hurry","title":"How One Hospital Brought Its C-Section Rate Down In A Hurry","publishDate":1431273670,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.\u003c/p>\n\u003cp>A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.\u003c/p>\n\u003cp>“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.\u003c/p>\n\u003cp>The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.\u003c/p>\n\u003cp>Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.\u003c/p>\n\u003cfigure id=\"attachment_25740\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4.jpg\">\u003cimg class=\"size-thumbnail wp-image-25740\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4-400x267.jpg\" alt=\"According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-960x641.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Decreasing C-sections results in “better health to mothers and better health to babies and lower costs,” said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. “That’s like a nirvana moment in health care.”\u003c/p>\n\u003cp>Experts have long been troubled by the wide variation of C-sections among hospitals nationally. (In California, the rates range from 18 percent to 56 percent.) Certainly there are instances in which C-sections are typically recommended – such as a baby in breech position. But the disparities suggest that decisions are being driven by factors other than medical necessity – such as doctors’ time constraints and malpractice concerns.\u003c/p>\n\u003cp>Over the past few years, there has been a coordinated push to cut C-section rates in other states and in \u003ca title=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" href=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" target=\"_blank\">births covered by Medicaid\u003c/a>, the health coverage program for low-income Americans.\u003c/p>\n\u003cp>Across California, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births%20http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" target=\"_blank\">data publicly released\u003c/a> by the California HealthCare Foundation, the Pacific Business Group on Health and others in the past few years have underscored the differences in how hospitals handle maternity care.\u003c/p>\n\u003cp>Despite the increased transparency, however, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for others.\u003c/p>\n\u003cp>“In quality improvement, we call it ‘the burning bridge,’” he said. “You can’t just stay still. You’ve got to move.”\u003c/p>\n\u003cp>\u003cstrong>Focus on Physicians\u003c/strong>\u003c/p>\n\u003cp>At Hoag, where more than 6,000 babies are born each year, Brooks and other administrators knew that they had to focus on changing the mindset and behavior of physicians. “Hospitals don’t do C-sections, doctors do,” she said.\u003c/p>\n\u003cfigure id=\"attachment_25742\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-e1431122104603.jpg\">\u003cimg class=\"size-thumbnail wp-image-25742\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-400x267.jpg\" alt=\"Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So they took some aggressive steps. First, they shared the data with all the physicians in the department without names -- then decided to reveal the names. Suddenly, everyone knew who had exceeded or come in under the average.\u003c/p>\n\u003cp>“There was a lot of upheaval,” Dr. Jeffrey Illeck, a community OB-GYN and the hospital’s obstetrics department chair. “None of us want to look bad in front of our peers. … And some looked horrible.”\u003c/p>\n\u003cp>Some physicians reacted with surprise and frustration. Initially, many attributed the high rates to the patients, saying they were older, had more complicated pregnancies or demanded scheduled C-sections.\u003c/p>\n\u003cp>Dr. Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.\u003c/p>\n\u003cp>“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”\u003c/p>\n\u003cp>VanBlaricom already tracked her own rates, which she said fell in the middle of the pack, and has only seen a small drop since. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor longer.\u003c/p>\n\u003cp>That’s what Hoag administrators were aiming for – a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.\u003c/p>\n\u003cp>“Doctors and patients look at cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”\u003c/p>\n\u003cp>The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, (PBGH) an organization of employers that is also working to bring down C-section rates around the state.\u003c/p>\n\u003cp>PBGH worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.\u003c/p>\n\u003cp>Hoag took other steps, too:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>New scheduling rules:\u003c/strong> In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they have to fill out a detailed form, with some requests needing special approval.\u003c/li>\n\u003cli>\u003cstrong>Improved patient education:\u003c/strong> The hospital encourages women to wait for labor to come naturally. If patients want an elective C-section, they have to sign a consent form in the doctor’s office that details the risks.\u003c/li>\n\u003cli>\u003cstrong>Engaged nurses in the effort:\u003c/strong> Nurses use various techniques to help laboring women avoid C-sections and receive end-of-year bonuses if they help the hospital reach certain goals on reducing surgical births.\u003c/li>\n\u003cli>\u003cstrong>Expanded its use of \"laborists\":\u003c/strong> A new obstetrics emergency room is staffed around the clock with doctors specifically assigned to monitor women in labor, deliver babies and respond to emergencies.\u003c/li>\n\u003c/ul>\n\u003cp>Dr. Alex Deyan, who delivered more than 500 babies at the hospital last year, used to turn away patients who wanted vaginal births after cesarean sections. With a busy private practice, Deyan said he couldn’t always be immediately available if labor didn’t go as expected and a woman needed a C-section. That changed with the laborist program.\u003c/p>\n\u003cp>“Having in-house doctors 24/7 is a huge benefit,” Deyan said. “I can be a little more patient.”\u003c/p>\n\u003cp>\u003cstrong>Good for Patients Too\u003c/strong>\u003c/p>\n\u003cp>Holly Grim appreciated Hoag’s approach. She knew she didn’t want a C-section with her second baby. Her first labor at another hospital in December 2013 was long and painful and ended with a cesarean section that kept her in the hospital for days. Her son was healthy, but she said, “this wasn’t exactly how I had it planned – not even close.”\u003c/p>\n\u003cp>This time, she needed to get back on her feet quickly so she could chase after her 16-month-old. She decided to switch to a doctor at Hoag. And in early April, she got her wish -- giving birth naturally to an 8-pound girl, Agnes.\u003c/p>\n\u003cp>The day after Agnes was born, the family was packing up to go home. She didn’t have any restrictions on lifting or driving, and she wasn’t in severe pain. This, she said, is how childbirth is supposed to be.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I’m feeling really good,” she said as she nursed Agnes, wrapped in a blanket decorated with pastel footprints. “I’m relieved I’ll be able to run around after my son.”\u003c/p>\n\n","blocks":[],"excerpt":"The hospital's tools included sharing each doctor's c-section rate with the entire obstetrics department.","status":"publish","parent":0,"modified":1431360759,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1431},"headData":{"title":"How One Hospital Brought Its C-Section Rate Down In A Hurry | KQED","description":"The hospital's tools included sharing each doctor's c-section rate with the entire obstetrics department.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"25735 http://ww2.kqed.org/stateofhealth/?p=25735","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/","disqusTitle":"How One Hospital Brought Its C-Section Rate Down In A Hurry","nprByline":"Anna Gorman, Kaiser Health News","path":"/stateofhealth/25735/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>NEWPORT BEACH, Calif.— Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.\u003c/p>\n\u003cp>A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.\u003c/p>\n\u003cp>“We were under intense scrutiny,” said Dr. Allyson Brooks, executive medical director of Hoag’s women’s health institute.\u003c/p>\n\u003cp>The C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above most others in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.\u003c/p>\n\u003cp>Within three years, Hoag had lowered its cesarean section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of women who had vaginal births after delivering previous children by C-section.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In medicine, this qualifies as a quick turnaround. And the story of how Hoag changed sheds light on what it takes to rapidly improve a hospital’s performance of crucial services, to the benefit of patients, insurers and taxpayers.\u003c/p>\n\u003cfigure id=\"attachment_25740\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4.jpg\">\u003cimg class=\"size-thumbnail wp-image-25740\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-4-400x267.jpg\" alt=\"According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/05/hoag-4-960x641.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">According to the Pacific Business Group on Health, surgical births cost about $7,000 more than vaginal births. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Decreasing C-sections results in “better health to mothers and better health to babies and lower costs,” said Stephanie Teleki, senior program officer at the California HealthCare Foundation, which helped fund the data collection and analysis by the California Maternal Quality Care Collaborative. “That’s like a nirvana moment in health care.”\u003c/p>\n\u003cp>Experts have long been troubled by the wide variation of C-sections among hospitals nationally. (In California, the rates range from 18 percent to 56 percent.) Certainly there are instances in which C-sections are typically recommended – such as a baby in breech position. But the disparities suggest that decisions are being driven by factors other than medical necessity – such as doctors’ time constraints and malpractice concerns.\u003c/p>\n\u003cp>Over the past few years, there has been a coordinated push to cut C-section rates in other states and in \u003ca title=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" href=\"http://kaiserhealthnews.org/news/early-elective-deliveries-leapfrog-group/\" target=\"_blank\">births covered by Medicaid\u003c/a>, the health coverage program for low-income Americans.\u003c/p>\n\u003cp>Across California, \u003ca title=\"http://www.chcf.org/publications/2014/11/tale-two-births http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" href=\"http://www.chcf.org/publications/2014/11/tale-two-births%20http://www.pbgh.org/storage/documents/PBGH_C-Section_NTSV_Variation_Report.pdf\" target=\"_blank\">data publicly released\u003c/a> by the California HealthCare Foundation, the Pacific Business Group on Health and others in the past few years have underscored the differences in how hospitals handle maternity care.\u003c/p>\n\u003cp>Despite the increased transparency, however, many hospitals don’t act until dollars are at stake, said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative. That’s what happened with Hoag, which Main said is now becoming a model for others.\u003c/p>\n\u003cp>“In quality improvement, we call it ‘the burning bridge,’” he said. “You can’t just stay still. You’ve got to move.”\u003c/p>\n\u003cp>\u003cstrong>Focus on Physicians\u003c/strong>\u003c/p>\n\u003cp>At Hoag, where more than 6,000 babies are born each year, Brooks and other administrators knew that they had to focus on changing the mindset and behavior of physicians. “Hospitals don’t do C-sections, doctors do,” she said.\u003c/p>\n\u003cfigure id=\"attachment_25742\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-e1431122104603.jpg\">\u003cimg class=\"size-thumbnail wp-image-25742\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/05/hoag-2-400x267.jpg\" alt=\"Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hoag Memorial Hospital in Newport Beach. In 2012, its c-section date was about 38 percent -- 5 percent higher than the state average. \u003ccite>(Heidi de Marco/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So they took some aggressive steps. First, they shared the data with all the physicians in the department without names -- then decided to reveal the names. Suddenly, everyone knew who had exceeded or come in under the average.\u003c/p>\n\u003cp>“There was a lot of upheaval,” Dr. Jeffrey Illeck, a community OB-GYN and the hospital’s obstetrics department chair. “None of us want to look bad in front of our peers. … And some looked horrible.”\u003c/p>\n\u003cp>Some physicians reacted with surprise and frustration. Initially, many attributed the high rates to the patients, saying they were older, had more complicated pregnancies or demanded scheduled C-sections.\u003c/p>\n\u003cp>Dr. Amy VanBlaricom, an OB-GYN who delivers about 25 to 30 babies a month, said she wasn’t opposed to sharing the data. But she said doctors were worried that the rates would be used to penalize them rather than to drive improvement.\u003c/p>\n\u003cp>“It’s very heated,” she said. “We should use this data as an opportunity rather than a polarizing topic.”\u003c/p>\n\u003cp>VanBlaricom already tracked her own rates, which she said fell in the middle of the pack, and has only seen a small drop since. But she said being aware that Hoag is monitoring the C-sections has changed how she thinks about her practice and has encouraged her to let women remain in labor longer.\u003c/p>\n\u003cp>That’s what Hoag administrators were aiming for – a realization among doctors that C-sections should not be undertaken lightly. They carry surgical risks, including serious infection and blood clots, and require longer hospital stays.\u003c/p>\n\u003cp>“Doctors and patients look at cesareans as an easy way to time the birth,” said Dr. Marlin Mills, chief of perinatology at the hospital. “But a C-section is not benign. It’s a big surgery.”\u003c/p>\n\u003cp>The costs are also well-documented. Surgical births cost nearly $19,000, compared to about $11,500 for vaginal births, according to the Pacific Business Group on Health, (PBGH) an organization of employers that is also working to bring down C-section rates around the state.\u003c/p>\n\u003cp>PBGH worked with the hospital on the financial side. It enlisted the help of some of the biggest local employers, including Disney, and another insurer, Blue Shield, to adjust payments so the hospital didn’t earn more from elective C-sections than vaginal births.\u003c/p>\n\u003cp>Hoag took other steps, too:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>New scheduling rules:\u003c/strong> In the past, doctors could simply call in with the woman’s due date and schedule the birth. Now, they have to fill out a detailed form, with some requests needing special approval.\u003c/li>\n\u003cli>\u003cstrong>Improved patient education:\u003c/strong> The hospital encourages women to wait for labor to come naturally. If patients want an elective C-section, they have to sign a consent form in the doctor’s office that details the risks.\u003c/li>\n\u003cli>\u003cstrong>Engaged nurses in the effort:\u003c/strong> Nurses use various techniques to help laboring women avoid C-sections and receive end-of-year bonuses if they help the hospital reach certain goals on reducing surgical births.\u003c/li>\n\u003cli>\u003cstrong>Expanded its use of \"laborists\":\u003c/strong> A new obstetrics emergency room is staffed around the clock with doctors specifically assigned to monitor women in labor, deliver babies and respond to emergencies.\u003c/li>\n\u003c/ul>\n\u003cp>Dr. Alex Deyan, who delivered more than 500 babies at the hospital last year, used to turn away patients who wanted vaginal births after cesarean sections. With a busy private practice, Deyan said he couldn’t always be immediately available if labor didn’t go as expected and a woman needed a C-section. That changed with the laborist program.\u003c/p>\n\u003cp>“Having in-house doctors 24/7 is a huge benefit,” Deyan said. “I can be a little more patient.”\u003c/p>\n\u003cp>\u003cstrong>Good for Patients Too\u003c/strong>\u003c/p>\n\u003cp>Holly Grim appreciated Hoag’s approach. She knew she didn’t want a C-section with her second baby. Her first labor at another hospital in December 2013 was long and painful and ended with a cesarean section that kept her in the hospital for days. Her son was healthy, but she said, “this wasn’t exactly how I had it planned – not even close.”\u003c/p>\n\u003cp>This time, she needed to get back on her feet quickly so she could chase after her 16-month-old. She decided to switch to a doctor at Hoag. And in early April, she got her wish -- giving birth naturally to an 8-pound girl, Agnes.\u003c/p>\n\u003cp>The day after Agnes was born, the family was packing up to go home. She didn’t have any restrictions on lifting or driving, and she wasn’t in severe pain. This, she said, is how childbirth is supposed to be.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I’m feeling really good,” she said as she nursed Agnes, wrapped in a blanket decorated with pastel footprints. “I’m relieved I’ll be able to run around after my son.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/25735/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry","authors":["byline_stateofhealth_25735"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_397"],"featImg":"stateofhealth_25736","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2023/08/possible-5gxfizEbKOJ-pbF5ASgxrs_.1400x1400.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/10/ATC_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0018_AmericanSuburb_iTunesTile_01.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. 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We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. 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Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/ME_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/01/OOW_Tile_Final.png","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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