Nepal’s Family Planning Clinics Feel the Effects of Trump’s Global Gag Rule
Nearly three years after the reinstatement and expansion of the Global Gag Rule, family planning clinics in Nepal are seeing dramatic effects on their programs. More than 150 Family Planning Association of Nepal staff have lost their jobs over the past year as funding cuts have forced layoffs and closures. In addition to the job losses, more than 100 vacant positions have not been filled.
Nepal liberalized its abortion law in 2002 as part of a strategy to combat high levels of maternal mortality, providing free access to terminations at government health facilities. Abortion is legal up to 12 weeks in all circumstances, up to 18 weeks in the case of rape or incest, and at any point in pregnancy if there is a fetal anomaly or a risk to the life or health of the pregnant person. However, awareness of the law is not widespread, and Nepal continues to have a high rate of illegal and unsafe procedures.
Planned Parenthood Exits the Title X Program
Planned Parenthood has withdrawn from the Title X (ten) program rather than comply with the Trump administration’s Domestic Gag Rule. The rule, which went into effect earlier this year, bars grantees from referring patients for abortion services and imposes onerous physical and financial separation requirements on providers who offer abortion. Opponents of the rule argue that it interferes with the doctor/patient relationship and requires providers to withhold information about pregnancy options from their patients.
Title X, the only dedicated source of federal funding for family planning for low income populations, provided grantees with $286.5 million in FY 2019, serving more than 4 million people—40 percent of whom obtained care from Planned Parenthood. The organization’s withdrawal from the program leaves states like Utah—where Planned Parenthood was the only Title X grantee—without any current Title X providers. In Minnesota and Vermont, Planned Parenthood served between 90 and 100 percent of Title X patients.
The rule is being challenged in court by Planned Parenthood, other provider groups, and the attorneys general of more than 20 states. In July, however, a federal appeals court ruled that the restrictions could take effect while the legal challenges were pending.
Dispensing a Year’s Supply of Birth Control Cuts Unintended Pregnancies
A study of female U.S. veterans, published in the Journal of the American Medical Association (JAMA), showed that unintended pregnancies decreased when users received a year’s supply of birth control pills, rather than being required to refill a prescription every three months, as is the current practice.
Data showed that 43 percent of patients who received birth control pills in three-month increments experienced at least one gap of at least a week between refills over the course of a year. Although the study only looked at female veterans, Colleen Judge-Golden, the study’s lead author, said that “gaps in contraceptive use are common among women in the general U.S. population as well, and extended dispensing for short-acting hormonal contraception is an evidenced-based strategy to help women use these methods consistently when that is their goal.”
Currently, 17 states and the District of Columbia require insurers to cover a 12-month supply of birth control at a single fill.
U.S. Supreme Court to Consider Louisiana Abortion Law
The Supreme Court announced on October 4 that it would hear a case involving a Louisiana law requiring doctors who perform abortions to have admitting privileges at nearby hospitals.
The Louisiana law is essentially identical to the Texas statute the Court overturned in 2016 in Whole Woman’s Health v. Hellerstedt. This time around, however, Trump appointees Neil Gorsuch and Brett Kavanaugh, both of whom have voted to limit abortion rights in the past, will have a chance to weigh in.
Oral arguments will take place this winter, and a decision is expected in June, only months before the 2020 presidential election.
Census Bureau Marks World Population Day
The U.S. Census Bureau estimates that on July 11, 2019—World Population Day—there were 7.58 billion people on the planet, meaning that global population has increased by more than 50 percent since reaching 5 billion in 1987. The Census Bureau also notes that global fertility rates continue to decline. It projects that sometime in 2020 or 2021, the worldwide growth rate will fall below 1 percent for the first time since 1950.
Abortion Bans Fall in Mexico, Australia
The Mexican state of Oaxaca has legalized abortion after local lawmakers voted 24-10 to permit the procedure in the first 12 weeks of pregnancy. With the change, Oaxaca, one of the poorest states in Mexico, becomes one of only two regions in the country to allow abortion, along with Mexico City, which legalized abortion in 2007. Elsewhere in the country, it remains illegal, with only very limited exceptions.
Legislators in the Australian state of New South Wales passed the Abortion Law Reform Act of 2019, permitting abortions up to 22 weeks into pregnancy and overturning legal restrictions that had been in place since the early 1900s. South Australia, which requires people seeking terminations to have two doctors certify that a pregnancy endangers their mental or physical health, is now the only Australian state with abortion restrictions remaining in effect.
California Requires Colleges to Offer Abortion Pills
California will become the first state to require public colleges and universities to make medication abortion available to students at campus medical centers. The law, which will take effect in 2023, will ensure access to abortion for the more than 400,000 women who attend the 34 campuses in the University of California and California State University systems. It will only be implemented if a state commission can raise more than $10 million in private donations to pay for it.
Medication abortion is an increasingly popular method of termination that is effective through the first 10 weeks of pregnancy. It usually consists of two pills. The first, mifepristone, blocks progesterone, stopping the pregnancy from growing. The second pill, misoprostol, causes uterine contractions that expel the pregnancy tissue.
… and Makes PrEP OTC
California will also begin allowing pharmacies to dispense HIV prevention drugs without a prescription. Studies show that the use of pre-exposure prophylaxis (PrEP) medications can drastically lower the risk of contracting HIV via sexual activity or IV drug use. For a person who has already been exposed to the virus, pharmacists will be allowed to dispense a 28-day course of post-exposure prophylaxis (PEP) medication.
ACOG Says All Hormonal Contraceptives Should Be OTC
The American College of Obstetricians and Gynecologists (ACOG), which has advocated since 2012 that the birth control pill should be available over the counter, has expanded that recommendation to include other hormonal birth control methods, including the patch, the vaginal ring, and the injection (most commonly marketed as Depo-Provera).
Rebecca H. Allen, a member of ACOG’s Committee on Gynecologic Practice, says:
A prescription is an unnecessary obstacle for some women to get their preferred contraceptive method. Over-the-counter hormonal birth control would be a step toward greater access to an essential component of women’s health care and give adolescents and women more options to manage their reproductive health.
ACOG also says that any plan to make these methods available over the counter should address the issue of cost, including for patients whose insurance currently covers their preferred method. Additionally, the Committee Opinion says there is no medical or scientific justification to limit access to over-the-counter contraception based on age.
 [and anyone else who can become pregnant and doesn’t identify as female]