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Improving Access to Miscarriage Care

October 15, 2014

logo_mcfAbout 15-20% of pregnancies end in miscarriage. Miscarriage can be a difficult experience for many women, as our medical director Linda Prine, MD discussed in her recent blog post. In honor of national Pregnancy and Infant Loss Remembrance Day on October 15th we would like to share our recent work on miscarriage care.

Studies have shown that when women are actively involved in deciding how to treat their miscarriage they have better health outcomes. The Reproductive Health Access Project (RHAP) is committed to improving access to all three forms of miscarriage care. In the past year we have done this through expanding our miscarriage training and research efforts.

In September RHAP selected our first cohort of Miscarriage Care Initiative (MCI) grantees. These five family physicians will receive intensive support from RHAP over the next year to integrate and expand miscarriage treatment in their primary practices.

The 2014-2015 grantees are:

Joey Banks, MD – Dr. Banks is a community preceptor at the Family Medicine Residency of Western Montana and is a family physician at Blue Mountain Clinic in Missoula, Montana. Her goal is to integrate miscarriage care into the residency program, including at the residency’s community health center.

Erin Hendriks, MD – Dr. Hendriks is faculty at the Wayne State/Sinai Grace Family Medicine Residency Program and is the Director of Women’s Health at the Thea Bowman Community Health Center in Detroit, Michigan. Her goal is to integrate medication and MVA for miscarriage management into her community health center and residency program.

Kristen Miranda, MD – Dr. Miranda is a provider at Clinica Alta Vista/La Clinica de la Raza community health center in Oakland, CA. She plans to offer medication and MVA for miscarriage management at her clinic and to be a referral source for the larger network of her community health center.

Glenda Rios, MD – Dr. Rios is faculty at the University of Illinois Medical Center in Chicago, Illinois. She has also been a provider at Mile Square Health system, a network of community health centers, for over 15 years. Dr. Rios is using the grant to offer medication and MVA for miscarriage management at her health center.

Tabatha Wells, MD – Dr. Wells is faculty at Southern Illinois University (SIU) School of Medicine and a provider at SIU Center for Family Medicine, a community health center in Springfield, IL. She plans to provide medication and MVA for miscarriage at her health center and help other staff at her site gain MVA skills as well.

Stay tuned for more updates on our MCI grantees. And soon RHAP will share information on our recent research on miscarriage care access in primary care.

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Reproductive justice ballot initiatives 2014

October 9, 2014

snowflake (2)The primaries are over and the candidates confirmed—now it’s time to really focus on the issues! As we’ve mentioned before, there’s a great deal at stake in the 2014 midterm elections, not least around issues of reproductive justice and women’s health. More specifically, three states have ballot measures that severely limit access to abortion care. If you live or vote in Colorado, North Dakota, and Tennessee, listen up!

Tennessee: Legislative Powers Regarding Abortion, Amendment 1

Amendment 1 in Tennessee would grant elected state officials the power to make decisions involving abortion laws without the involvement of their constituents. Amendment 1 would add a new section to Article 1 of Tennessee’s constitution, allowing state legislators to repeal any measure that protects abortion rights. For example, should Roe v. Wade be overturned, the Tennessee Supreme Court would lack the power to ensure that abortion remains legal in the state. At its most basic level, Amendment 1 allows elected officials to determine the reproductive choices of Tennessee women, denying women’s right to privacy. Women might also struggle to get exemptions, even in cases of rape, incest or risks to their own health. Ultimately, Amendment 1 could mean that Tennessee women will no longer have the right to choose abortion. Find out more at Vote No on 1 Tennessee.

Colorado: Definition of “Personhood” and Child Initiative, Amendment 67

If approved by voters, Amendment 67 would define pregnancies as “child” and “person” under the Colorado criminal code. As such, unlawful termination of pregnancy without the mother’s consent would be considered a homicide. Supporters of the amendment say that this bill protects expectant mothers who suffer miscarriages by accident or assault. While this bill may sound well-intentioned, it will effectively limit women’s right to choose, and could open a dangerous door to future restrictions on abortion and reproductive health decisions in Colorado. Connect with those fighting this amendment at Vote No 67.

North Dakota: “Life Begins at Conception” Amendment, Measure 1

As it stands, abortion services are already quite limited in North Dakota. Laws are currently in place that restrict insurance coverage for abortion, require parental consent for minors and subject women to mandatory wait periods and biased counseling. If approved by voters, Measure 1 would add a new section to the State’s Constitution, defining life as starting at conception. This measure would restrict fertility treatments, prohibit stem-cell research, ban various forms of birth control, and outlaw abortion even in cases of rape, incest or risk to the mother’s health. Not only does Measure 1 threaten a women’s right to control over her body and her life, it also directly threatens the well-being of pregnant women with health risks. Limiting women’s access to common forms of birth control would increase the already high rate of unintended pregnancies (in the United States currently at 49%) and negatively impact public health in both the state and the country. For more info visit The North Dakota Coalition for Privacy in Health Care.

On a brighter note, ballot initiatives in Oregon and Illinois have the potential to promote reproductive health!

Oregon: Equal Rights for Women Initiative, Measure 89

Also known as the Equal Rights Amendment, this measure would amend the State Constitution to ensure that no state or political entity can infringe upon or deny a woman of her rights, privileges or immunity as a citizen because of her sex. This measure will also repeal current legislation that allows denial of these privileges so long as the denial is justified by a specific biological difference between men and women. With this measure on the ballot, Oregon’s voters have the opportunity to add Oregon to the list of 20 states that have made sure that women and men will be treated equally before the law, regardless of future legislators’ and justices’ personal opinions! To get involved in promoting this measure visit VoteERA.org.

Illinois: Birth Control in Prescription Drug Coverage Question

Voters in Illinois will have the opportunity to vote on whether prescription birth control should be covered in health insurance plans that cover prescription drugs. This move is on the ballot as a non-binding advisory question and will not directly change any laws or amendments. However, this advisory question is still extremely important. Answering this question has the potential to send a strong statement to Illinois state officials regarding access to birth control as a basic health care right for women. To get involved visit the Illinois Votes for Birth Control Campaign.

Before heading to the polls this November, we encourage you to educate yourself on what’s at stake in your state. It’s up to you to ensure that no one loses their right to choose what is best for themselves, their bodies, and their future.

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RHAP’s #GOTV campaign in action: events recap

October 1, 2014

CelebrateNVRD

Registering voters in Union Square, NYC

The Reproductive Health Access Project (RHAP) hosted two events last week to highlight the importance of voting in the midterm election on November 4th. The upcoming midterm election is particularly important because hundreds of state legislators, 36 governors, 33 senators and the entire house of representatives are up for re-election. These elected officials write, pass, and enact laws that directly impact access to contraception and abortion care.

September 23rd was National Voter Registration Day. RHAP spent the day in New York’s Union Square registering voters, handing out hundreds of voter resource flyers and answering questions about the upcoming election. If you haven’t registered yet there may still be time. Find out your state’s voter registration deadline and register to vote online.

On Saturday, September 27th, RHAP friends and supporters packed the Soda Bar in Brooklyn for V to Shining V, a national event created by Lady Parts Justice. Lisa Maldonado, RHAP’s executive director, opened the event with an introduction and a reminder of why we were all gathered there—to celebrate women and strategize how to protect access to reproductive health, especially in this crucial midterm election. She then opened the floor to our emcees for the evening, local sketch comedy group, Buzz Off, Lucille.

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Buzz Off, Lucille and Anoush Froundijan in designer paper exam gowns, RHAP t-shirts, and post-it notes dress

Wearing paper exam gowns over their RHAP t-shirts, the hilarious ladies of Buzz Off, Lucille kept the crowd energized with some excellent feminist comedy. The lineup included comedians Naomi Ekperigin (who writes for Broad City) and Alise Morales. Interactive artist Anoush Froundijan walked around in a dress constructed of colorful post-its asking folks to write their answer to the question: “If your vagina could talk, what would it say?”

A few lucky attendees won some great raffle prizes, including handmade IUD earrings, a gift basket from the Chocolate Room, a $100 certificate to P.J. Clarke’s, ice cream from Ample Hills, donuts from R & D Foods, wine from Fermented Grapes and a vibrator from Babeland. Everyone went home with a great goodie bag filled with information on registering vote, resources for researching candidates and helpful items, including male and female condoms!

Lauren Alexander from the NY Civil Liberties Union spoke about the Women’s Equality Act, highlighting this piece of legislation that directly affects New Yorkers.

The most heartfelt moments of the evening came when several family physicians spoke about the importance of providing comprehensive reproductive health care. These incredible doctors touched us all with stories about the work that they do for their patients on a daily basis. Dr. Linda Prine, RHAP’s medical director, honored the hard work, dedication and passion of the health care  professionals who help make quality reproductive healthcare accessible to everyone.

As the event wrapped up, everyone was sent home with a worksheet and resources to find out who their elected officials are and where they stand on reproductive health issues. Ultimately, the empowering combination of celebration and activism inspired us to go to the polls on November 4th!

Help us keep the momentum going. Find out where your candidates stand on reproductive health issues, mark your calendars for November 4th and get your friends to join you at the polls!

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Upcoming Get Out the Vote Events with RHAP

September 18, 2014

Eunice the Uterus, the V to Shining V mascot

National Voter Registration Day: Get out the vote with RHAP in Union Square!

National Voter Registration Day is a national effort to get as many people to register to vote as possible. The goal is not to advocate on behalf of a particular candidate or party, but to make sure everyone has access to voting come November 4th. Stop by the RHAP table in Union Square on September 23, and make your voice heard!

Date: Tuesday, September 23, 2014
Time: 8:30 am-7:00 pm
Location: Union Square, South Plaza (corner of 14th and Union Square East)
RSVP here!
Search for NVRD events near you!

 

Come celebrate V to Shining V with RHAP on September 27th!

On September 27th, people across the country will gather to celebrate V to Shining V, a national day dedicated to strategizing how to change the laws that are disintegrating our reproductive access—all while celebrating female pride! Have a drink with RHAP at the Soda Bar in Brooklyn, NY for our very own V to Shining V celebration. Register to vote and get information about the upcoming election and local legislation affecting reproductive health, while enjoying performances from feminist comedy group, Buzz Off Lucille and others. V to Shining V is a national effort created by Lady Parts Justice, a collective of comedians and entertainers, including Daily Show creator Lizz Winstead and comedian Sarah Silverman. If you can’t make it to Brooklyn, see if you can find an event near you!

Date: Saturday, September 27, 2014
Time: 6:00 pm – 8:00 pm
Location: Soda Bar 629 Vanderbilt Avenue, Brooklyn, NY 11238
RSVP: online at v2shiningv.eventbrite.com
This event is free and anyone who registers will receive an awesome goodie bag!
Find a V to Shining V event near you!

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“I was treated better when I had an abortion.”

September 16, 2014

Linda Prine, RHAP’s medical director, moderates the Access List, a clinical listserv with more than 1,000 subscribers all dedicated to providing abortion care within family medicine and primary care settings. This blog regularly features Linda’s postings to the Access List.

Early Pregnancy Loss Awareness

I was shocked by the hurt in her voice when our patient started telling us about the care she received in the previous weeks when she started to have some vaginal bleeding early in her pregnancy. First she called her OB/Gyn, who did not come to the phone to talk to her but whose office staff told her to go to the nearest emergency room. This was a highly desired pregnancy, so it was very scary to her that she needed to go to the ER. She was afraid it meant something bad, not only for her pregnancy, but for her own health. She was at home, in Northern New Jersey, and went to her local community hospital. There she waited more than six hours before she saw a doctor, another three hours until she got an ultrasound, and then another four hours before anyone told her what was happening. Finally the doctor reported, “The pregnancy is not viable, but since your bleeding is light, there is nothing that needs to be done right now, so you can follow up with your gyn.” The doctor was brusque and hurried away, implying that he had “real emergencies” to deal with. They gave her a copy of the ultrasound and discharged her. The words that jumped out at her from the written report read “no fetal heart beat.”

The next morning, she called the OB/Gyn’s office and again was only able to speak to clerical staff. They told her to fax her ultrasound report and they would call her back. Late that afternoon, they called her back to tell her she was scheduled for a D&C in the hospital three days later and to fast after midnight the night before. She had so many questions: “Why had this happened? What was a D&C (dilation & curettage)? Was it the same procedure she’d had years ago when she had an abortion?”  She had not been told to fast that time and had been awake for the procedure. Everyone had been really nice to her at the abortion clinic and had answered all her questions. Now she was being treated like she didn’t matter at all and that her pregnancy “didn’t matter.”

Since she had three days before she was supposed to show up at the hospital, she started to ask around. Through her office-mates she heard about our family practice, which is close by her job. Our staff knows to get someone in right away who is bleeding in early pregnancy. We saw her the afternoon the same day she called. It was a long visit because we did more than just give her all the options for care that we could provide in our office: expectant management, or “letting nature take its course”; misoprostol medication; and/or an in-office Manual and Vacuum Aspiration (MVA) procedure. We also helped her process what she had been through, reassured her that she had not caused her miscarriage, and that she would be able to get pregnant again. It was so sad that she felt demeaned and belittled by the medical system when her situation was so heartbreaking and scary to her.

Miscarriage is so common, it should not be marginalized, and there are rarely times that ER care is needed. Yes, an urgent ultrasound should be done, but that’s not impossible to arrange in most places, and more and more family medicine residency practices have on-site ultrasound. I would really like to see family medicine step up to the plate and own miscarriage care. This woman was so very, very grateful to us for our consideration of her needs – but that should be normal! It shouldn’t feel like special treatment to be respected, to have your worries addressed and to have your grieving acknowledged.

It was sort of nice to hear (although sad that it was coming from such painful feelings) that she’d been treated better when she had an abortion.  And it was good to see how much better she felt after our conversation where we explained everything about her miscarriage and her treatment options.

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6 steps for community based organizations to make a difference in the midterm elections

September 9, 2014

shutterstock_fbA simple voter registration drive can make a big difference this November 4th! Helping your clients register to vote is easy, legal and can be integrated into daily operations. Your non-partisan involvement through voter registration is a critical step to engaging new or infrequent voters. Many community based organizations such as health centers, non-profits, schools, and civic organizations serve populations that are typically underrepresented in the political process. The community sees these organizations as trusted messengers that represent and amplify their voice. Better serve your clients by integrating voter registration into your operations this September!

6 easy steps to voter registration for community organizations:

1. Find out your state’s voter registration procedures and get the forms:
For most states the rules are as simple as printing the forms and sending them in on time. But a few states have extra rules so double check your state’s voter registration procedures. For many states voter registration forms are available online for download and printing. Find out procedures and download the voter registration form from your state’s Secretary of State office, local Registrar of Voters, or Board of Elections. Or use the National Mail Voter Registration Form, which can be downloaded in multiple languages and is accepted in most—but not all—states.

2. Offer the voter registration form to the clients:
When clients visit your organization give them the opportunity to fill out a voter registration form. It may seem easier to just have the forms available in the lobby, but asking each client if they want to fill it out and then handing them the form will provide much better results. You can incorporate this activity into daily processes such as sign-in or regular meetings.

3. Double check that important information is filled out:
Make sure that your clients check the boxes verifying that they are a United States citizen and are at least 18 years old. Check that they use their full residential address, including apartment number, not a post office box. Have them fill out their entire Social Security number if they can. The form requires at least the last four digits of the Social Security number be filled in.

4. Learn if your state has a voter ID law:
30 states require voters to present identification at the voting booth, and 15 states require picture ID. Find out your state’s voter ID laws. Then let clients know if they need to bring a form of ID with them on Election Day.

5. Offer to mail in their voter registration form:
Explain that clients are welcome to mail in their registration, but assure them that your organization is turning in many people’s cards and can make sure that theirs gets to the right place in time.

6. Submit the voter registration forms by your state’s deadline:
Mail or bring in the completed voter registration cards to your state’s Office of the Secretary of State or your local Registrar of Voters. Find out your state’s voter registration deadline. Most states require you to register to vote at least 30 days before the election.

For more information check out these great voter registration resources:

DoSomething.org: Conduct a Voter Registration Drive
Non-Profit Vote
Rock the Vote
National Voter Registration Day

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Reproductive health in the voting booth

September 2, 2014

This year it has become clearer to me than ever that our elected officials – at every level – are controlling reproductive health care access.

Our political representatives have the power to write, pass and enact laws that directly impact access to contraception and abortion care. They appoint judges who make critical legal rulings limiting or mandating health care. They appoint officials who create policies and programs that provide and oversee health care across the country.

In 2013 state legislators passed over 141 laws on reproductive health care (half of which restrict access to abortion).  This year we have seen the power of the judiciary branch of our government, from the Supreme Court’s groundbreaking decision undermining employer coverage of contraception, to the recent federal court ruling on the restrictive anti-abortion laws in Texas. Local elected officials have an impact too –  consider the city laws protecting protecting crisis pregnancy centers.

On November 4th we will have the opportunity to weigh in on who our elected officials will be at the national, state and local level. There is a lot at stake this election year:

-36 states will be electing governors, the largest turnover in 60 years.
-All 435 seats in the House of Representatives are up for election.
-33 seats in the Senate are up for election.
-Hundreds of state and local legislative seats are up for election all across the country.

We have an opportunity to shape the discussion and affect who elected leaders are.

The Reproductive Health Access Project has been thinking a lot about what we, as a small non-profit dedicated to ensuring that everyone has access to reproductive health care, can do ensure that our country’s laws and policies support universal access to reproductive health care. Our expertise is clinical, but we can’t deny that profound effect that laws and policies have on clinical care. So, we have decided to dedicate the months of September and October to urging our colleagues, friends and followers to register to vote. We are also providing information on how to help others in your community register to vote and to sharing information and resources so that come November 4th voters who care about access to reproductive health care access can make informed decisions at the ballot box.

This campaign starts now.  Get out the vote. #GOTV

Here are three things you can do to make a difference this election.

1.  Register to vote in time for the November 4th election. If you don’t know if you are registered, check here. If you need to register, you can register on online.
2.  Learn where your candidates stand on issues you care about. Make sure to find out not only what they say, but what they do. Check this page, especially in October, for updates on state and local candidates records on reproductive health access.
3.  Vote on November 4th. Not sure where you vote? Find out here.

Think of joining the GOTV campaign as a bit of preventative medicine for our country. Careful, thoughtful action now will have a great impact on our nation’s health and well-being in years to come.

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Why I provide abortions

August 14, 2014

whyiprovideabortionsDr. M. is an abortion provider in Buffalo, NY and a member of our Family Medicine Reproductive Health Network. He has chosen to speak anonymously to protect himself and his family. We recently asked him what moves him to provide abortions and this was his answer.

It’s simple. I provide abortions because it is basic medical care and I am a general practitioner. The level of opposition to basic medical care simply astounds me.  At their core, obstacles to birth control and abortion are sex-discrimination.

I ask men “have you ever walked into a store and bought birth control?”. Of course, in the vast majority of cases, the answer is yes–almost every man has bought a pack of condoms, myself included. Then I ask things like “did you have to go to a pharmacy? Were you able to buy it without talking to someone? Did you need a prescription? Did anyone shame you? Were you able to afford it?” The barriers are sex discrimination! Men in political office are making medical decisions for women, or at the very least, creating a burdensome environment to access care. You know that if men could get pregnant you’d be able to get an abortion easily.

I have a daughter. If she needed an abortion, I’d do whatever I could – I’d take her to Europe if I had to. That’s my privilege—I’m very lucky. And that’s the way it’s always been. If you have money, getting an abortion is no problem. You can pay for the travel, or you can pay for the psychiatrist to deem it necessary. On that level, restrictions to access are not only sexist, they are classist as well.

I care for many patients from surrounding states that have enacted strict abortion regulation. I’ve treated a 14 year old whose cousin risked life in prison to bring her across state lines to get an abortion because they lived in a state where parental consent was necessary. The 14 year old had been raped by a family member and other family members were incarcerated, so consent was impossible to obtain. What struck me is that this cousin, a kid really, had to risk life in prison because a politician somewhere thought he knew better about why someone might need an abortion. Have these guys ever talked to women? Why do they think they have the right to judge?

You asked why I perform abortions. I think the better question is how can I not?

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New Faces: Stephanie Blaufarb and Gabrielle deFiebre

July 25, 2014

6-GGStephThe Reproductive Health Access Project (RHAP) staff is proud to welcome two new members to our team.

Gabrielle (GG) deFiebre, MPH joins us as our research associate. GG earned her bachelor’s degree from New College of Florida and her master’s degree in public health from the CUNY School of Public Health at Hunter College. GG interned with RHAP during her last year of graduate school, helping conduct our qualitative miscarriage study and using the results as part of her master’s essay. As the research associate GG helps design, implement, and analyze the results of several research projects, including our annual survey of graduating family medicine residents trained in abortion care and our new survey of miscarriage care in community health centers.

In May Stephanie Blaufarb joined RHAP as our program and administrative associate. Stephanie became passionate about reproductive health during her Peace Corps service in the Republic of Vanuatu where she worked as a community health worker. She organized adolescent health education camps and women’s health workshops covering HIV/AIDS, STIs, and family planning. Stephanie is currently pursuing a master’s degree in public health at Hunter College. Prior to joining RHAP Stephanie worked at the Fort Tryon Park Trust, Columbia University Medical Center, and the Big Sister Association of Greater Boston.

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13 ways providing abortion care makes me a better doctor

July 22, 2014

woman doctor woman patient 3Linda Prine, RHAP’s medical director, moderates the Access List, a clinical listserv with more than 1,000 subscribers all dedicated to providing abortion care within family medicine and primary care settings. This regular column features Linda’s postings to the Access List. At our recent Reproductive Health Access Project gathering at Society of Teachers of Family Medicine annual meeting, we discussed some of the ways in which providing abortion care makes us better doctors. I pulled together everyone’s comments and am sharing below. Providing abortion care makes me a better doctor because:

1.   It teaches me the real meaning of being patient centered.

2.   It taught me how to reserve judgment and understand that I can’t walk in anyone else’s shoes.

3.   It makes me brave because I don’t really think I’m a brave person. But when I do this work that I intensely believe in, in a state that would like to criminalize it, I know that I am being brave and that makes me a stronger person.

4.   It makes my procedure skills better for IUDs and endometrial biopsies and really all procedures.

5.   It taught me how to really, really listen to my patients. It lets me make abortion a normal part of the life cycle. Since I take care of women I’ve known since they were infants, and they know me and trust me and I can make the abortion a normal part of medical care for them and let them know I think it’s a good decision for them and be a supportive person who they know cares about them as I provide this care.

6.   It has helped me discuss so many difficult areas with patients: morality, spirituality, and ethics.

7.   It gives me a chance to let women know that I respect their dreams for their future and that I will help them get there by providing the abortion they need so that they can have that life back that includes pursuing those dreams.

8.   It has been a way for me to improve my counseling skills, my listening skills, my empathy with patients, so many things I need for being a good doctor. I have gotten better at due to providing abortions in my own office and all that it takes.

9.   It’s all transferable to other areas of medical care: including understanding systems issues and politics of medicine and really everything!

10. It has helped me become a better teacher of residents because I have to be mindful of the patient and the resident and be sure that both of them are doing ok all the time.

11. It helped me be there to support women through a particularly difficult moment – it sometimes occurs to me that my patient will remember this day for the rest of her life.

12. It helped me to recognize that abortion can be something super important or something routine and normal, depending on the particular patient’s situation.

13. It is the thing that gets me “jazzed” which helps keep me interested in other aspects of family medicine. It taps into all aspects of myself within my work. Thinking, feeling, troubleshooting, coordination, love and family and friends and all that is truly important in life.

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