Sexual and Reproductive Health Issues for Underserved Women

1. Sexual and Reproductive Health Issues for Underserved Women Lourdes A. Rivera, JD Managing Attorney National Health Law Program May 25, 2006

2. Reproductive Health Status of Women of Color • African American and Latina Women highest rates of reported new AIDS cases (48.2/100,000, 11.1/100,000, respectively) in 2004. • Rate of 6.4 for NA/AN; 1.6 for API • In 2000, teen pregnancy rate: African-Americans -- 153/1,000 teens; 138/1,000 for Latinas; 55/1,000 for Whites. All declining. • More than 1/3 of US women need publicly-supported contraceptive services and supplies because income is below 250% federal poverty level • Cervical cancer disproportionately affects Latinas, African American and Korean women in Los Angeles County. Sources: The Alan Guttmacher Institute/LAC DHS

3. Reproductive Health: Abortion • Unintended pregnancy: 98.4/1,000 African-American women ages 15-44; 69.4/1,000 for Latina; 35.5/1,000 for Whites • Poor women 4x’s as likely to experience unplanned pregnancy as higher income woman • In 2000, 21/1,000 women ages 15-44 had abortions • 49/1,000 African American; 33/1,000 Latina; 13/1,000 White • Rate of abortion increased for women with family income below 200% poverty and women on Medicaid between 1994 – 2000 Source: The Alan Guttmacher Institute

4. Barriers To Comprehensive Reproductive Health • Cost/affordability of health services • Immigration status • Lack of language and cultural accessibility • Lack of comprehensive information and sex education • Breaches of confidentiality • Geographic access/lack of transportation/lack of childcare • Discrimination and lack of access for LGBTQ • Social beliefs & gender roles within communities • Ideological restrictions of health entities and provider refusals • Dissatisfaction with doctor/health care visits • Low education levels/low health literacy

5. Barrier to Reproductive Health: Lack Of Health Coverage • Among women, Latinas are at highest risk for being uninsured with almost 40% lacking coverage in 2004. • Latinas: 38% uninsured • African American: 17% uninsured • White: 13% uninsured • Latinas least likely to have regular doctor or to have had an Ob-Gyn visit in past year; 1 in 3 report delaying or going without care in past due to cost Source: The Henry J. Kaiser Family Foundation

6. Health Insurance Coverage of Women, by Race/Ethnicity, 2004Source: The Henry J. Kaiser Family Foundation

7. Medicaid’s Role in Reproductive Health • Coverage to over 7 million women of reproductive age (15-44) (11.5% of all women in that age & 36.6% with incomes below poverty line) – prevention, screening and treatment services • Nearly 2/3 of spending on publicly financed family planning • Over 1/3 of all births in the U.S. • All 50 States and the District of Columbia -- breast and cervical cancer treatment for women otherwise not be eligible for Medicaid. • Single largest public funding source for HIV/AIDS care in the U.S. Sources: Kaiser Family Foundation & Alan Guttmacher Institute/Smith & Moody, Health Management Assoc./Centers for Medicare and Medicaid Services.

8. Medicaid Under Attack • Cuts to Medicaid - Deficit Reduction Act • Cut $6.9 B over 2006-2010; $28.3 B over 2006-2015 • Higher premiums and co-pays • Family planning no longer mandated benefit • Show birth certificate/passport to apply if citizen • Administration’s proposed FY 2007 Budget • Federal Medicaid funding cuts equal to $14 billion over the next five years and $35.5 billion over ten

9. Health Coverage for Immigrants • Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) – a.k.a “Welfare Reform” • Five-year ban for new, otherwise qualified immigrants • Affidavits of support by sponsors • Concerns about “public charge” • Only Emergency Medicaid for unqualified immigrants • Some states provide Medicaid prenatal care for immigrants, regardless of immigration status • SCHIP coverage of “unborn” • Otherwise county, charity services, community clinics • What will happen with immigration bill and Inhofe amendment?

10. Reproductive Health Policies, Politics and Issues • Parental Involvement Laws • 34 states with parental involvement laws (21 require consent) • “Teen Endangerment Act” (H.R. 748) • Provider/institutional refusals for contraception • Emergency contraception and oral contraception • Politics of the FDA • EC access over-the-counter • HPV immunization – FDA and CDC’s Advisory Committee on Immunization Practices

11. Reproductive Health Policies, Politics and Issues • Rights of “Unborn” • Unborn Victims of Violence Act -- first law to recognize zygote as separate victim of crime, instead of protecting pregnant women from violence • SCHIP Coverage of Fetuses as “qualified children” • Abstinence-only education

12. Reproductive Health Policies, Politics and Issues: Attacks on Abortion Access • Federal funding restrictions on abortion • Hyde Amendment on Appropriations– Since 1976 • Abortion ban – “Partial-Birth Abortion” ban – SCT to Review • Weldon Amendment – Labor-HHS- Education Appropriations • Criminalization of assisting minors – “Teen Endangerment Act”/”Child Custody Protection Act” • States move to pass bans – e.g., S.D.

13. As said by Law Prof. Dorothy Roberts…. • “Reproduction is not just a matter of individual choice. Reproductive health policy affects the status of entire groups. It reflects which people are valued in our society; who is deemed worthy to bear children and capable of making decisions for themselves. Reproductive decisions are made within a social context, including inequalities of wealth and power.”

14. A human rights view of Reproductive Health • International Conference on Population and Development (Cairo, 1994) & International Conference on Women (Beijing, 1995). • A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters related to the reproductive system and to its functions and processes. • Implies that people are able to have a satisfying and safe sex life; capability to reproduce and freedom to decide if, when and how often to do so.

15. Reproductive Health (cont.) • Right to: • Be informed • Have access to safe, effective, affordable and acceptable methods of family planning of their choice • Have access to other methods of regulation of fertility which are not against the law • Have access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance if having a healthy infant.

16. Sexual Health • Ability to Enjoy Mutually Fulfilling Sexual Relationships • Freedom from Sexual Abuse, Coercion, or Harassment • Safety from STDs/STIs • Success in Achieving or in Preventing Pregnancy

17. Health System Obligations • Respect • Refrain from interfering directly or indirectly with the enjoyment of the right to health • Protect • Prevent third parties from interfering with the freedom of people to enjoy the right to health

18. Health System Obligations (cont.) • Fulfill • Ensure that people have access to a system of heath care that provides equal opportunity for everyone [CESCR General Comment on Health]: • Availability – functioning public health and health care facilities, goods and services, and essential drugs are available in sufficient quantity. • Accessibility – non-discrimination; physical accessibility; affordability; information accessibility • Acceptability – ethically and culturally appropriate; sensitive to gender and life-cycle requirements; respect confidentiality; improve heath status. • Quality – scientifically and medically appropriate and of good quality.

19. Women of Color: A Vision of Reproductive Justice for All • The economic, social, political power and resources to make healthy decisions about our bodies, sexuality and reproduction • Addresses reproductive oppression -- control and exploitation of women and girls through our bodies, sexuality and reproduction by families, communities, institutions and society • Fights equally for the right to have – and not to have – a child Sources: Asian Communities for Reproductive Justice & SisterSong

20. Resources • Source: Rebecca J. Cook, et. al., Reproductive Health and Human Rights (Clarendon Press 2003). • Source: Asian Communities for Reproductive Justice, A New Vision for Advancing our Movement for Reproductive Health, Reproductive Rights, and Reproductive Justice (2005), www.reproductivejustice.org. • Jael Silliman, et al., Undivided Rights: Women of Color Organize for Reproductive Justice (South End Press 2004). • Dorothy Roberts, Killing the Black Body: Race Reproduction and the Meaning of Liberty (Vintage Books 1999).

21. Resources • Collective Voices (Sister Song Women of Color Reproductive Health and Sexual Rights Collaborative, Atlanta, GA), www.sistersong.net. • The Women’s Health Activist (National Women’s Health Network, Washington, D.C.), www.womenshealthnetwork.org. • The Health Advocate (National Health Law Program, Los Angeles, CA), www.healthlaw.org.