St. Louis, MO – An 11th-hour rule that takes effect Sunday is stirring major controversy by allowing people who provide reproductive health services to refuse information or procedures that violate their consciences. Pro-choice advocates say that, based on the ruling, some women in Missouri could lose access to most forms of birth control.

The ruling by the Bush administration reinforces protections for health care providers who object to providing abortion-related services based on moral or religious beliefs. Starting January 18, pharmacists will be able to refuse to fill birth control prescription, emergency rooms can refuse to give emergency contraception to rape victims, and health providers don't have to discuss birth control options if it violates their consciences. Pro-lifers praise the rule, saying current laws prohibiting discrimination based on religion don't go far enough to protect employees.

Paula Gianino of St. Louis Planned Parenthood says the ruling could restrict health care access at nearly 600,000 health care centers across the nation that work with the U.S. Department of Health and Human Services.

"That really puts the conscience determinations of individuals above and beyond the health care needs of citizens in this county."

Gianino says Planned Parenthood is considering a hiring freeze to avoid being sued for discrimination by job applicants. Opponents in Congress are already mobilizing to rescind the move, which Gianino feels could take as long as six months. She also says that, with the current economic uncertainty, this is no time to leave women out in the cold and no time to give Congress additional work.

"Given all of the crises facing the 2009 Congress, I think it's very upsetting that President Bush and his administration have put this on the plate of the new Congress."

Despite 200,000 comments opposing the action, Health and Human services issued the new ruling one month ago. Those supporting the new rule expect a battle with the Obama administration over its implementation.



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Results of a new study show more American women are falling behind on getting critical breast cancer scans.

Nowhere is this perhaps more important than in Iowa, a state that is among the nation's leaders in lethal breast cancer cases.

Breast cancer is the second leading cause of cancer death among women in the United States. It claims about 40,000 women every year.

Researchers have historically broken down mammography use by state and demographics, but the University of Iowa's Iowa Cancer Registry Research Director - Sarah Nash - said that for the first time, this study took critical social factors into account when studying mammography use.

"And so they looked at several different things," said Nash, "and the strongest predictors among these social drivers of health were life dissatisfaction, feeling socially isolated, experiencing lost or reduced employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier to care."

Nash said the results of this study point to the need to address social drivers and not just health care access when figuring out who needs help and how they can get it.

The Centers for Disease Control and Prevention estimates that only 65% of women ages 50 to 74, with three or more health-related social needs, are up to date with their mammograms.

Despite acknowledging the social determinants that can stand between a woman and her mammogram, Nash and other researchers have said the number one factor is cost.

"So, to address costs, we can think about making sure preventive care remains at no co-pay," said Nash. "We have a program in Iowa called the 'Iowa Care for Yourself' program, which helps provide low- or no-cost screening for Iowans who are under insured."

Scientists estimate early detection and treatment can reduce breast cancer deaths by almost a quarter.




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In the final days of the legislative session, Kentucky Senate lawmakers could consider the "Momnibus" bill, which would increase access to critical prenatal and post-birth care for new moms and babies.

House Bill 10 would extend the state's voluntary home-visitation program for expectant parents to when a child reachs age three, and would include lactation assistance and telehealth.

Bonnie Logsdon, a board-certified lactation consultant and birth doula, said many women have to return to work a few weeks after giving birth and often lack the tools or knowledge to have a positive lactation experience.

"They need access to those quality supplies," she stressed, "and they need someone who can teach them how to use the pump, which is again where that lactation support would come into play."

The Momnibus bill would add pregnancy to the list of qualifying life events, so pregnant people could get health-insurance coverage and begin prenatal care visits.

Kentucky has the second-highest maternal mortality rate in the nation, according to the Centers for Disease Control and Prevention.

The bill would also expand mental-health counseling through the Lifeline for Moms Psychiatry Access Program.

In Letcher County, Courtney Rhoades said she's had a complex pregnancy, and has struggled to cope with stress and maintaining her physical health. She noted it's critical that first-time moms like herself have a place to turn for support, where they don't feel judged.

"Then to be finding out we're having twins," Rhoades said, "I am really excited to know that there's these programs available that otherwise I didn't know about."

Renee Basham, executive director of Hope's Embrace, said communities increasingly are aware of the role doulas can play in pre- and post-natal care. She added many of her clients need assistance.

"A lot of the clients that we work with, some of them have support, a lot of them don't," said Basham. "Doulas are extra important in that role, because if we weren't there, they wouldn't have anybody with them as they gave birth."

House Bill 10 would open the door to more research on the role of doulas in the birth experience, and how their expertise is being used for care and to reduce disparities in the Commonwealth.


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Advocates for women veterans, who've experienced sexual trauma while serving in the military, are asking state lawmakers for much-needed funding.

Previous legislation backed the creation of two sexual trauma liaisons at community-based organizations in the state, but funding never came to fruition.

Executive Director of the Augusta-based Sisters-in-Arms Center, Rebecca Cornell du Houx, said lawmakers have a chance to help veteran survivors rebuild their lives.

"To have a consistent clinician there to provide that trauma treatment to the woman veteran in a place that they're safe," said Cornell du Houx, "I think, can really, really support their recovery."

Cornell du Houx said one in three women soldiers experience some form of sexual trauma while in the military but many incidents go unreported.

There are more than 10,000 women veterans currently living in Maine.

Women veterans are one of the fastest-growing sectors of the homeless population, and are four times more likely to become homeless than their male peers.

Researchers also now identify military sexual trauma as the biggest factor driving a more than 60% increase in suicide rates among women veterans since 2001.

Cornell du Houx said while group therapy is available to these veterans, state funding would provide for more formalized treatment - especially for those coming off active-duty.

"I think if people knew the stories of what had happened to these women while they were in the service, just really disheartening stories of assault," said Cornell du Houx, "I think that they wouldn't hesitate to fund a position so that they could get help."

Cornell du Houx said sexual trauma is most prevalent among lower-ranking seventeen and eighteen-year-olds, who are influenced to think that reporting an incident is a betrayal of a fellow soldier.

She said it's important to support those who have come forward, to advocate for themselves and others, and who took an oath to serve their country.





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