These new guidelines encourage ob-gyns to do the following: ask patients about their gender open-endedly on their patient intake forms rather than requiring they check “male” or “female,” to post LGBT-inclusive nondiscrimination policies visibly in their offices, and train staff to handle transgender patients professionally and with compassion.  ACOG says that physicians must be prepared to offer gender-nonconforming patients the same basic preventive services as their cisgendered patients (those who identify as the gender they were assigned at birth), such as STD testing and cancer screenings.

This is a huge, much-needed victory in LGBT health and wellness. In October 2010, the National Center for Transgender Equality and the National Gay and Lesbian Task Force released the results of the largest survey of transgender people on healthcare discrimination to date, and the results were dismal. Not only are trans people at elevated risk for most of our nation’s worst health problems, but according to the report:

• Respondents reported more than four times the national average of HIV infection, 2.64 percent in our sample compared to 0.6 percent in the general population, with rates for transgender women at 3.76 percent, and with those who are unemployed (4.67 percent) or who have engaged in sex work (15.32 percent) even higher.
• Over a quarter of the respondents reported misusing drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression.
• A staggering 41 percent of respondents reported attempting suicide compared to 1.6 percent of the general population.
• Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming.
• Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent).
• Harassment: 28 percent of respondents were subjected to harassment in medical settings.
• Significant lack of provider knowledge: 50 percent of the sample reported having to teach their medical providers about transgender care.  (see Source)

Reproductive healthcare is often stressful for transgender patients even when they aren’t treated disrespectfully by their providers, because many transgender people experience gender dysphoria, a feeling of extreme discomfort and anxiety with their assigned genders. Gender dysphoria is what many trans people refer to when they talk about feeling “trapped in the wrong body,” and it frequently includes strong feelings of disgust about their sexual anatomy.

A transgendered man with strong feelings of revulsion and anxiety about the parts of his body that are still “female” would find receiving care for something like an ovarian cyst upsetting under the best of circumstances. The last thing this man should have to worry about is whether he’ll have to argue with health practitioners who insist despite his protests that they’re going to make every effort possible to preserve his ovaries because he “might want to be a mother someday.”

Hopefully the new recommendations from the American College of Obstetricians and Gynecologists will make that kind of transgender healthcare horror story a thing of the past – or at least a glaring anomaly. No one should have to receive health care in a hostile environment, and we commend ACOG for recognizing that ignorance and disrespect from providers is a serious and attention-worthy barrier to healthcare access.

The DPW’s rationale for this change is that it will reduce waste, fraud, and abuse, but the facts do not support this argument.  Tens of thousands of Pennsylvanians could lose their food stamps with no benefit for Pennsylvania’s taxpayers from this misguided and ill-conceived policy: Pennsylvania already has among the lowest SNAP fraud rates in the country and Pennsylvania will not save a single penny of state money by implementing this change because it will deprive Pennsylvania of federal SNAP dollars and raise administrative costs.  The change will also hurt Pennsylvania’s economy by reducing the economic activity that SNAP generates through community spending.  Furthermore, the asset limit applied in the test—$2,000 for most households and $3,250 for seniors—is outdated, having been originally proposed almost three decades ago, when families could afford more with less money.  The asset test also sends the wrong message by penalizing and discouraging savings, thereby harming hardworking and frugal lower income individuals, including the working poor, individuals who have been laid off recently, and seniors.

Denying food stamps to people who need it exacerbates the effects of poverty, which already disproportionately impacts women, who are more likely than men to face barriers to gainful employment due to discrimination, pregnancy, caretaking responsibilities, and the effects of domestic and sexual violence.  Lower income individuals and families lack access to nutritious food: poorer neighborhoods have fewer supermarkets than wealthier neighborhoods, and nutritious food is generally more expensive than less nutritious food.   This lack of access to nutritious food results in poorer health, including malnutrition, obesity, diabetes, heart disease, and many other health conditions.

For the long term health of Pennsylvania’s citizens and its economy, DPW should think twice about limiting the poor’s access to nutritious food.  Urge Governor Corbett to stop efforts to implement this short-sighted, harmful asset test for SNAP.  The change will negatively affect the lives of real people for whom food stamps make the difference between having a nutritious meal and going hungry or resorting to unhealthy but less expensive food options.  The result for Pennsylvania could be an increase in the number of individuals who go hungry and who are more likely to suffer life-long health consequences.

To learn more about Pennsylvania’s proposal to institute a harmful asset test for SNAP benefits, check out the Greater Philadelphia Coalition Against Hunger.  To learn more about the impact of poverty on women’s health, stay tuned for the Women’s Law Project’s forthcoming report, Through the Lens of Equality: Gender Bias, Health, and a New Vision for Pennsylvania’s Women.

• New York became the largest state to legalize same-sex marriage
• Secretary of State Hillary Clinton made a historic speech, insisting that the protection of LGBT individuals from discrimination is an essential part of the international effort to further human rights
• For the first time, two women shared the traditional “first kiss,” a Navy homecoming tradition
• Don’t Ask, Don’t Tell, the policy that barred gay servicepeople from serving openly in the military, was repealed
• President Obama and Attorney General Holder issued a letter to Speaker Boehner stating that the Administration will no longer defend the Defense of Marriage Act, which states that opposite-sex marriage is the only marriage allowed under federal law
• President Obama’s administration extended benefits to federal employees in same-sex domestic partnerships through executive order

Rivers and Barnett stated that “surveys of U.S. households have found rates of wife-to-husband violence “remarkably similar” to those of husband-to-wife violence.  And an early cross-cultural survey did not find that men were significantly more aggressive than women.”  However, Henry takes issue with the data they cite, noting several critiques of studies showing similar rates of violence committed by women and men that Jack C. Straton, Ph.D. noted in his article “The Myth of the ‘Battered Husband Syndrome.’”

Straton, in critiquing studies Straus co-authored in 1980, said that researchers used a “set of questions that cannot discriminate between intent and effect.  This so called Conflict Tactics Scale (or CTS) equates a woman pushing a man in self-defense to a man pushing a woman down the stairs.”  The studies also “excluded incidents of violence that occur after separation and divorce, yet these account for 75.9 percent of spouse-on-spouse assaults, with a male perpetrator 93.3 percent of the time, according to the U.S. Department of Justice,” and did “not include sexual assault as a category although more women are raped by their husbands than beaten only.  Adjusting Straus’ own statistics to include this reality makes the ratio of male to female spousal violence more than 16 to one.”  Numerous other critiques of the study can be found within Straton’s article.  Henry also notes that “[t]he survey’s finding is also based on claims of innocence by friends and family members on behalf of the accused. [However,] [t]here have been several cases where the accused admits to committing domestic violence or sexual assault and family and friends continue to deny it simply because they can’t handle the thought that their loved one could commit such an act.”

While Rivers and Barnett noted that women usually suffer more severe injuries than men in instances of domestic violence, Henry gives more detail to illustrate the severity of the disparity.  She states that “[a]fter analyzing the results of the U.S. National Crime Surveys, Straton writes that ‘sociologist Martin Schwartz concluded that 92 percent of those seeking medical care from a private physician for injuries received in a spousal assault are women.  That same study shows that one man is hospitalized for injuries received in a spousal assault for every 46 women hospitalized.’”  Henry ends her article by stating that “I am very aware that there are male victims of domestic abuse and I strongly believe that we need to provide them with support…I am also aware that people sometimes make false accusations.  But neither of these facts should be used to minimize the degree to which girls and women take the brunt of household violence.”

To learn about efforts to end domestic violence in the U.S. and what you can do to help in the effort, visit the National Network to End Domestic Violence website.  You can learn about what the Women’s Law Project has done to “improve system responses to violence against women” here.

The authors of the study postulated that their findings might reflect “‘changing social, economic, and political contexts in which reproductive services were needed…over the last decade’” but added that “new provisions for care under healthcare reform may bring some of those women back into care.” Shortly after healthcare reform was passed, the Guttmacher Institute released a news brief which summarizes some of expansions of reproductive healthcare services that healthcare reform will bring. It notes that “a provision expanding eligibility to all Americans with a family income below 133% of the federal poverty level will allow 16 million more Americans to join Medicaid by 2019 than would otherwise be the case.” The Medicaid expansion will allow more Americans access to the program’s guarantee of family planning services without cost sharing. Additionally, healthcare reform will allow those who are currently uninsured with incomes above 133% of the federal poverty line to purchase private insurance through the new health care exchanges, most of which will provide a similar package of reproductive healthcare to what Medicaid offers.

Given the risky behaviors among young people reported by the National Campaign to Prevent Teen and Unplanned Pregnancy, it is evident that supporting the implementation of healthcare reform as well as other efforts to make reproductive healthcare services more widely available is incredibly important. The Campaign’s data showed that among the young people polled, “nearly half of those who are in a sexual relationship either don’t use contraception at all or use it inconsistently, and almost 20% of all respondents predict that they’ll have unprotected sex within the next three months.” The result of this risky behavior is that “Seven in 10 pregnancies in the 18-to-29 age group are unintended, and men and women in their 20s have among the highest rates of sexually transmitted infections of any age group, including chlamydia, gonorrhea and syphilis.”

If you are interested in learning more about this issue, the National Survey of Family Growth study is available online, published by the American Journal of Public Health. 

To learn more about the Women’s Law Project’s work on women’s health, including on the implementation of Healthcare Reform and on reproductive health, visit our website, and stay tuned for our forthcoming publication, Through the Lens of Equality: Discrimination, Health, and a New Vision for Pennsylvania’s Women.

Ward and her husband both run small businesses which both took huge hits in the recession. With a reduced income, Ward and her husband struggled to support themselves, their two children, pay their mortgage, and continue paying for insurance. Eventually, they had to decide whether to continue paying their mortgage or continue paying for their insurance. They chose to keep their house, a decision Ward says was “a nerve-racking gamble” which they lost when she was recently diagnosed with breast cancer which requires expensive treatments.

Ward details how being uninsured made it harder for her to get well. She says, “Not having insurance amplifies cancer stress. After the diagnosis, instead of focusing all of my energy on getting well, I was panicked about how we were going to pay for everything.” Luckily, Obamacare’s Pre-existing Condition Insurance Plan (PCIP) came to her rescue. Ward explains that PCIP is

…Part of President Obama’s healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.)

Ward recognizes that even though PCIP served her needs well, “It’s not perfect, of course, and it still leaves many people in need out in the cold.” However, it is nonetheless a resource that could save lives and that has made her reconsider her former anti-Obamacare stance. In a follow-up to her original opinion piece she challenges those who don’t relate to the struggles she and her family endured, “If your sister or mother lost her job and health insurance, and then turned up with breast cancer, what would you do? Would you let her die? Would you pick up the cancer tab yourself?, or would you tell her about PCIP?”

To find out more about the current controversies surrounding Obamacare and why it is important to stand up for health care reform that gives those who would otherwise be uninsured life-saving coverage, read some of our past blog posts about the issue.

In the letter submitted last week on behalf of ten civil rights organizations, WLP requested that the OCR enforce its requirement that schools adjudicate sexual harassment and violence complaints on an equal and consistent basis.  The organizations’ request referenced a statement in the OCR’s recent April 2011 “Dear Colleague” letter which stated no preferential treatment would be given to athletes in such circumstances, providing that “[i]f a complaint of sexual violence involves a student athlete, the school must follow its standard procedures for resolving sexual violence complaints.  Such complaints must not be addressed solely by athletic department procedures.”   

Given the shocking allegations made against Penn State regarding its purported failure to sufficiently respond to reported child sexual abuse perpetrated by a member of its athletic department, this request for the OCR to conduct a thorough and comprehensive review of Penn State’s procedures is not only timely, but essential.  Indeed, in their letter to the OCR, the civil rights groups cited disturbing statistics regarding the frequency of sexual assault by student athletes in general, and significantly, point out numerous red flags with respect to Penn State’s poor track record in this area.  Specifically, the groups cite several examples of publicly available information that highlight incidents suggesting special treatment and slaps on the wrist for athletes committing sexual assault and violence.  The letter also calls for routine reviews to assess whether schools across the country respond differently to complaints of sexual harassment and violence when athletes and athletic department staff are implicated.

Please visit http://www.womenslawproject.org/ for more information.

The Obama administration’s decision imposes a dangerous obstacle in the pathway of protecting women’s health.  Indeed, the FDA’s recommendation to make emergency contraception available without restriction was overwhelmingly supported by medical and scientific authorities, including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Society of Adolescent Health and Medicine.  In a letter sent on December 19^th to President Obama and Secretary Sebelius, the Women’s Law Project (WLP) urged the President to reevaluate and reconsider this decision and to take future action to protect, not undermine, women’s health. Among the many concerns cited in its letter, WLP noted that when our country faces approximately 3.1 million unintended pregnancies each year, unrestricted access to safe and effective contraception is vital.  WLP also pointed out that there is simply no evidence to suggest that making emergency over-the-counter contraception available encourages young women to begin having sex at a younger age, or engage in sex with more partners.  Further, the FDA’s recommended change would have made emergency contraception – which remains behind the pharmacist’s counter for women ages 17 years and older – far more accessible to women of all ages, an important development given the vast number of unplanned pregnancies among women in their twenties and thirties.

 To voice your objection about the Obama’s administration poor decision with respect to Plan B, call and/or write a letter to President Obama and Secretary Sebelius today:

President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
202-456-1111

Secretary Kathleen Sebelius
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775 

Please visit www.womenslawproject.org for more information.

Known as “TRAP laws,” (“Targeted Regulation of Abortion Providers”), similar measures have been enacted in several states and are a tactic recommended by the National Right to Life Committee for closing down women’s clinics. Every medical and public health organization in Pennsylvania that has weighed in on the matter, including the unquestioned medical authority, the American College of Obstetricians and Gynecologists, opposes SB 732.

If SB 732 is allowed to take effect, most or all of the 20 existing freestanding clinics in Pennsylvania may have to stop offering abortion care temporarily, while they hire architects and contractors to transform their small clinics into sophisticated medical facilities; or they may close permanently, if they determine that their costs of making the required upgrades are prohibitive (particularly in light of the unavailability of public funding for abortion care). Instead of attending to the 37,000 Pennsylvania women who rely on them for safe care each year, providers will have to install hospital-grade elevators, acquire parking spaces and covered entryways, install specialized HVAC systems, double or triple the size of their procedure rooms, and rip up their flooring and install new flooring, among many other unnecessary and costly physical plant specifications.

The Women’s Law Project is busily at work on a legal strategy. The Governor could avoid not only litigation but also the potential of grievous harm to women simply by vetoing this bill. Please call him today, and tell him to veto SB 732, for the sake of the one in three women who will need abortion care by age 45.

GOVERNOR CORBETT: 717-787-2500
Honorable Tom Corbett
Governor of Pennsylvania
225 Main Capitol Building
Harrisburg PA 17120
PLEASE DELIVER A MESSAGE TO GOVERNOR CORBETT:
RESPECT WOMEN’S HEALTH – VETO SB 732.

Lower courts have split on whether the ACA is constitutional.  See, e.g., Seven-Sky v. Holder, 2011 U.S. App. LEXIS 22566 (D.C. Cir. Nov. 8, 2011) (upholding the constitutionality of the ACA); Thomas More Law Ctr. v. Obama, 651 F.3d 529 (6th Cir. 2011) (upholding the constitutionality of the ACA); But see Florida v. Dep’t of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011) (holding that the Medicaid expansion program is constitutional because it is not unduly coercive, but striking down the individual mandate by finding it exceeds Congress’ authority under the Commerce Clause). 

The Supreme Court will review four questions related to the constitutionality of the ACA: (1) whether the Anti-Injunction Act prevents lawsuits from challenging the individual mandate right now (if so, then the legal challenges cannot be in court until after the individual mandate goes into effect); (2) if the Anti-Injunction Act does not apply, is the individual mandate provision constitutional; (3) if the individual mandate is unconstitutional, can the rest of the ACA remain in effect without it; and (4) whether the ACA’s Medicaid expansion program is unconstitutional?

The Women’s Law Project believes that the ACA is a constitutional exercise of Congress’ broad powers under the Commerce and Spending Clauses of the United States Constitution.  See, e.g., Wickard v. Filburn, 317 U.S. 111 (1942); Heart of Atlanta Motel v. United States, 379 U.S. 241 (1964); New York v. United States, 505 U.S. 144 (1992).  The decision not to purchase health insurance is an economic activity subject to congressional regulation under the Commerce Clause because, over time, those uninsured individuals will impose costs on taxpayers and others when they inevitably utilize healthcare during the course of their lives.  The Medicaid expansion program is also constitutional because it is a voluntary program that is not too coercive to the states.  Even the 11^th Circuit, which invalidated the individual mandate, held that the Medicaid expansion program is constitutional. 

If the Supreme Court invalidates the ACA, the decision will jeopardize the health of millions of Americans.  According to Media Matters, the law has already benefitted 4 million seniors with Medicare, 4 million small businesses, 2 million children, and 1 million young adults. The Herndon Alliance points out that, among other benefits, when the ACA is fully implemented “a child getting sick [would] no longer [be] a reason for a lifetime of denial of care [and] preventive services will give our children and our parents better chances for healthier and longer lives.”

In particular, women will suffer if the ACA is not upheld.  The ACA benefits women in many ways, including by prohibiting insurers from using pregnancy, domestic violence, and sexual violence as “pre-existing conditions” to deny women health coverage, prohibiting the widespread practice of charging women higher insurance premiums than men for the same insurance (known as gender rating), guaranteeing maternity coverage, and ensuring new plans cover preventative services such as Pap smears and mammograms.

The ACA is constitutional and vitally important to improving the health of American citizens, particularly women.  The WLP strives to eliminate sex discrimination in insurance and to expand health coverage, and full implementation of the ACA is essential to meeting these goals.  For more information on the ACA and WLP’s work on access to health care, see WLP Health Care Reform.