A Colorado birth control program that has cut unintended pregnancies and abortions by nearly half since 2009 will stay alive for at least one more year thanks to $2 million in donations from private foundations.
The rescue of the highly-touted program comes after Republican lawmakers earlier this year killed a bill that would have provided $5 million in public funding for IUDs and other long-acting reversible contraceptives for low-income teens and young women. Colorado health officials estimate that the IUDs and other devices have saved at least $79 million in Medicaid costs for unintended births, but some opponents claimed that IUDs are abortifacients and refused to approve funding in the Republican-controlled Senate.
From mid-2009 to mid-2015, the Susan Thompson Buffett Foundation funded a pilot effort in Colorado with a $25 million grant. The Colorado Family Planning Initiative provided teens and young women with more than 36,000 free or low-cost IUDs or other long-acting birth control devices.
The newest data from the Colorado Department of Public Health and Environment show a 48 percent drop statewide in unintended pregnancies and abortions. Births among teens ages 15 to 19 fell from 6,201 in 2009 to 3,361 in 2014, while abortions declined from 1,711 to 939 in the same period.
The 48 percent reduction is up from a 40 percent drop through 2013.
Teens and young women get the free and low-cost devices at 68 family planning clinics across Colorado. The Affordable Care Act requires health insurance companies to pay for birth control, but some plans don’t cover implants since they’re more expensive up front. State Medicaid programs increasingly are covering IUDs and implants, but patients who are uninsured or don’t qualify for Medicaid often need help paying for birth control. The Colorado Family Planning program has been essential to safety-net clinics. Managers used the grant funds to pay for the devices in advance, then worried about reimbursements later.
The lack of public funding for the IUD program in Colorado comes as health leaders across the country are racing to expand access to long-acting contraceptives. The most popular device in Colorado now is an arm insert called the Nexplanon. About 50 percent of Colorado patients request that device since it’s so easy for doctors to insert. Other patients opt for traditional vaginal IUDs known as the ParaGard and the Mirena.This story also ran in Health News Colorado. It can be republished for free (details).
At least 15 states are working on some kind of boost to the use of IUDs or implants, according to leaders at the Association of State and Territorial Health Officials. A study from the U.S. Centers for Disease Control and Prevention earlier this year found that more teens are waiting to have sex and that Colorado is far ahead of the rest of the country in teen use of long-acting contraceptives.
As funding withered for the Colorado program at the end of June, some county health agencies were creating waiting lists, while others were trying to stockpile IUDs for the neediest patients.
This week, 12 foundations rode in to the rescue with pledges to keep the program alive until the middle of next year. Their money will pay for an additional 6,000 devices.
“I feel fortunate that we have that community to turn to in what I considered an emergency situation,” said Dr. Larry Wolk, Colorado’s top health official.
While he celebrated the program’s survival through private funding, Wolk said that he and Democratic Gov. John Hickenlooper plan to keep fighting for taxpayer support. The governor will include funding for the birth control program in Colorado’s budget, Wolk said.
“We’ve made the case for a public benefit and we need public investment,” said Wolk, chief medical officer and executive director of the Colorado Department of Public Health and Environment. “That’s where ultimate sustainability lies.”
IUDs and other long-acting forms of contraception cost more initially than birth control pills, but they last from three to 10 years. The up-front cost for an implant or IUD is about $325 for clinics that get federal discounts or about $800 to $900 at full cost. By comparison, the discounted price for birth control pills is about $23 a month and the full price is about $70 a month. Without help affording birth control, some teens struggle to pay the initial cost of an implant. If they’re on the pill, they must get refills every couple of months and have to remember to take the pill every day. Imperfect use cuts effectiveness.
Since the Colorado legislature torpedoed funding, the evidence of success has only improved.
“We’re going to go back with our even more remarkable results,” said Wolk, a pediatrician with a specialty in treating teens.
County health officials celebrated the news that the program will survive for at least one more year.
In Jefferson County, Colorado’s fourth largest, health officials started creating waiting lists earlier this summer to be sure that they would have some IUDs on hand each month.
Kelly Conroy, nurse manager for clinic services for Jefferson County Public Health, said the program’s popularity is surging.
“The word is definitely getting out. We have a lot of patients who come in and specifically ask for the devices by name. A lot of it is word of mouth, friends and family. A friend will be on Mirena (an IUD). They will know which one they want — hormonal or non-hormonal. People are coming in way more educated,” Conroy said.
Since Conroy and her colleagues knew funding from the state was in jeopardy, they started hunting for funds elsewhere to be sure they could have IUDs and other devices on hand. They worked to bill insurance companies or Medicaid for devices they were implanting so they could recoup as much money as possible to pay for other devices. On average, she said, patients were having to wait about three weeks.
Now health officials should be able to stop creating a waiting list and provide devices for those who want them right away.
“We’re absolutely thrilled,” Conroy said. “We are a safety net for a lot of clients who are uninsured and underinsured. We don’t want to put any obstacles in their way. We certainly don’t want anyone to have an unintended pregnancy.
“Our ultimate goal is empowering not just women, but families with the ability to know that they can make the choice (to have a baby) when they’re ready,” Conroy said.
Evidence shows that cutting teen pregnancy rates also reduces high school dropout rates. Along with direct savings for Medicaid — births costs about $11,000 each — supporters of the IUD program liked the idea that better birth control can dramatically improve outcomes for girls. Those who get a good education go on to earn higher incomes, thus reducing poverty rates and cutting reliance on Medicaid and other programs for people living in poverty.
Health officials across the country have been meeting with Colorado leaders for about a year to learn about the IUD program.
“Other states are very excited about the results from Colorado,” said Lisa Waddell, chief of community health and prevention for the Association of State and Territorial Health Officials. “All states are results-oriented and want the best outcomes for adolescents, women and families.
“There’s a tremendous amount of energy around learning from Colorado and other states and looking at that return on it investment. What does it take (to start this program)? How do you leverage different partners?”
Waddell said many states are much more interested in IUDs for several reasons. They’ve seen the success in Colorado and are paying more attention to long-term benefits, not just up-front expenses. IUDs are much safer now after having had a tarnished reputation decades ago. The Affordable Care Act requires coverage for birth control, and research is showing that IUDs and other long-acting devices work much better than other birth control methods. At the same time, increased transparency in health costs is driving much greater attention to getting the best bang for the buck.
“In the last couple of years, there’s been this convergence of this best evidence coming out and this drive to make sure we’re purchasing the best health care,” Waddell said. “These are highly effective devices…You’re seeing a systems change.”
According to the CDC, the failure rate with IUDs and other long-acting devices is less than 1 percent, while birth control pills fail at a 9 percent rate and condoms don’t work 18 percent of the time.
Nationally, only 7 percent of women use IUDs or other long-acting devices.
Waddell’s group represents Dr. Wolk and his colleagues. Because of the extensive interest in the issue, they convened a “learning community” on long-acting contraception. The group met in person last year and holds regular virtual sessions.
Six states that have already changed their policies on long-acting birth control led the way. They are Colorado, Georgia, Iowa, New Mexico, Massachusetts and South Carolina. Six more states are slated to join the group shortly and leaders from the 12 states will meet in person again in October.
Waddell says 50 percent of pregnancies in the U.S. are unintended. One of the programs that has been most popular in other states is to offer women who have just given birth an IUD or other long-acting device while they’re still in the hospital after having had a baby. Medicaid will pay for those devices and health officials say it makes great sense to implant the device while the woman is in the hospital.
“They’re generally pretty motivated to get a contraceptive device that would allow their body to recover,” Waddell said.
Along with postpartum use of IUDs, South Carolina health officials have been focusing on using long-acting birth control as a method for driving down stubbornly high infant mortality rates. Premature births that can put babies in jeopardy are higher among teens and others who get pregnant unexpectedly.
Driving down the number of unwanted pregnancies should also result in fewer infant deaths, Waddell said.
Consumer demand is also central to the growth in popularity of IUDs and other long-acting devices, said Ellen Pliska, director of family and child health programs for the health officials’ group.
“Since the momentum has gotten started, more women are aware that it’s a viable option. We’ve been hearing that word of mouth has been incredible, particularly among teens. If one ‘influencer’ gets involved, they’re going to tell everybody about it,” Pliska said.
The 12 foundations that so far have pledged support for the Colorado effort are:
· The Ben and Lucy Ana Walton Fund of the Walton Family Foundation
· Buell Foundation
· Caring for Colorado Foundation
· Chambers Family Fund
· The Colorado Health Foundation
· The Colorado Trust
· Community First Foundation
· The Community Foundation Serving Boulder County
· Global Health Foundation
· Kaiser Permanente Colorado
· The Women’s Foundation of Colorado
Wolk said some of the money will be used to expand training so that many more providers will know how to insert IUDs and other devices.
While Wolk supports efforts to give IUDs to teens and women who have already had babies, he thinks it’s much better to reach out to them and provide the most reliable contraception before they get pregnant the first time. He’d like to set up a system comparable to the public funding for vaccines, which, like IUDs, cost a lot for providers to keep on hand. A steady stream of funding would provide two options. If a woman has private or public insurance, providers can give them IUDs and get reimbursed. If they don’t have coverage and still want long-acting contraception, they can still get help.
“We’d have (devices) for uninsured on one side and insured on the other,” said Wolk. “That’s my vision.”
If you’re the parent of a school age child, you are probably thinking about sleep these days. More specifically, you may be wondering how you will possibly get your child back on a sleep schedule for school after a summer of late nights and mornings sleeping in.
Here’s one tip, based on a recent study on sleep led by researchers at Brown University: get rid of bright screens at night. Especially if your child is a young teen or tween.
The study, published online in the Journal of Clinical Endocrinology & Metabolism, found that children between the ages of 9 and 15 in the early stages of puberty were particularly sensitive to light at night compared to older teens. Researchers conclude: “The increased sensitivity to light in younger adolescents suggests that exposure to evening light could be particularly disruptive to sleep regulation for this group.”
From the Brown news release:
In lab experiments, an hour of nighttime light exposure suppressed their production of the sleep-timing hormone melatonin significantly more than the same light exposure did for teens aged 11 to 16 who were farther into puberty.
The brighter the light in the experiments, the more melatonin was suppressed.
Among 38 children in early to middle puberty an hour of 15 lux of light (think dim “mood” lighting) suppressed melatonin by 9.2 percent, 150 lux (normal room light) reduced it by 26 percent, and 500 lux (as bright as in a supermarket) reduced it by 36.9 percent. The 29 teens in the late or post-puberty stage were also affected, but not as much. Exposure to 15 lux did not suppress melatonin at all, 150 lux reduced it 12.5 percent, and 500 lux reduced it by 23.9 percent.The effects were the same for boys and girls.
“Small amounts of light at night, such as light from screens, can be enough to affect sleep patterns,” said study senior author Mary Carskadon, professor of psychiatry and human behavior in the Alpert Medical School of Brown University and director of chronobiology and sleep research at the E.P. Bradley Hospital in East Providence, R.I. “Students who have tablets or TVs or computers — even an ‘old-school’ flashlight under the covers to read — are pushing their circadian clocks to a later timing. This makes it harder to go to sleep and wake up at times early the next morning for school.”
I asked Carskadon what parents can do to help. Here’s her emailed response:
- Make a plan for sleep: Set a bedtime for that will provide enough time to sleep—and keep as close to it as you can
– Get bright light every morning upon wake up to help move the internal clock stay at an earlier time that can help enhance sleep onset
– Avoid light at night before bedtime to keep the internal clock from moving later
– Avoid “arousing” activities in the evening; have a wind-down time to relax for about 30 minutes before bedtime
– Don’t sleep with cell phone on, nor the computer, TV, or any other technology (including lights) in the bedroom
– Stick as closely as you can to the sleep schedule on weekends
– Avoid caffeine after school
– Do not nap after 4 pm
– Allow for some fun every day and enjoy life!
The law says insurance companies must pay for mental health benefits the same as they do everything else. Addiction as much as diabetes. Depression as much as cancer. But around the country, consumers are taking their insurers to court saying the companies are refusing to pay up. The insurance providers say mental health is complicated, and keeping costs down is part of their job.
Read More on Mental Parity:
In commemoration of Constitution Day, the Law Library of Congress will host a discussion about the importance of religious liberty in America and its historical connection to the U.S. Constitution with Princeton University professor of jurisprudence Robert P. George and Supreme Court correspondent Jess Bravin of The Wall Street Journal.
The discussion will take place at 1 p.m. on Wednesday, September 16, in the Montpelier Room, located on the sixth floor of the Library’s James Madison Memorial Building, 101 Independence Avenue S.E., Washington, D.C. The event is free and open to the public; tickets are not required.
This public event will serve as the Law Library’s annual commemoration of Constitution Day and Citizenship Day – a U.S. federal observance to commemorate the signing of the Constitution, and “recognize all who, by coming of age or by naturalization, have become citizens.” Constitution Day was established by Congress in 2004 to recognize the ratification of the U.S. Constitution on September 17, 1787.
George is McCormick Professor of Jurisprudence and founder and director of the James Madison Program in American Ideals and Institutions at Princeton University. He is also a visiting professor at Harvard Law School and vice-chairman of the U.S. Commission on International Religious Freedom.
Bravin has covered the Supreme Court for The Wall Street Journal since 2005, following postings as the paper’s United Nations correspondent and editor of The Wall Street Journal/California weekly. Prior to joining the Journal, Bravin wrote for newspapers including the Chicago Tribune, the Los Angeles Times, the Philadelphia Inquirer, the San Francisco Chronicle and the Washington Post, and for magazines ranging from Harper’s Bazaar to Spy.
File this one under: You can lead a horse to water…
Researchers at the University of Vermont report what they characterize as a “heartbreaking” finding: Many schoolkids are trashing the fruits and vegetables they are now served as part of a federal law that was supposed to nudge the kids toward healthier food choices.
The study, published online in the journal Public Health, concludes that kids are putting more fruits and vegetables on their trays, as required by the Healthy, Hunger-Free Kids Act of 2010 (which took effect in 2012 and was championed by First Lady Michelle Obama). However, the children ate fewer of these items after the law took effect and often dumped the produce straight into the trash.
“It was heartbreaking to see so many students toss fruits and vegetables into the trash right after exiting the lunch line,” Sarah Amin, Ph.D, a UVM researcher in nutrition and food sciences and the study’s lead author, said in an interview.
As part of the study, researchers captured images of kids’ school lunches before they ate and then again right before they dumped uneaten foods into the trash. So, for instance, the child might choose a school lunch (pictured on the left) of chicken nuggets, mac and cheese, green beans and milk. But, when the child is done eating, it’s clear the greens beens remain untouched.
The study concludes:
Children consumed fewer (fruits and vegetables) FVs and wasted more FVs during the school year immediately following implementation of the USDA rule that required them to take one fruit or vegetable at lunch. Average waste increased from one-quarter cup to more than one-third of a cup/tray, with about one-eighth cup/tray more FVs discarded, or a total of about 56 cups/day/school (based on an average of 400 lunches served/day).
Researcher Amin, who will soon begin a post doctorate fellowship at Tufts, said that while the initial findings might seem disheartening and show some unintended consequences of the federal law, it’s worth remaining hopeful.
She pointed out that “this was the first update to these regulations in 15 years and kids were really acclimated to how the environment was before,” and not used to choosing either one fruit or one vegetable with lunch.
“Maybe you can’t just put these foods in front of them and expect them to eat,” she said. “But it may just be too soon.”
For younger kids entering kindergarten, for example, “this may work,” Amin said, because it’s all the children know. “But for older kids used to the old system, this may rock their world because they’re just not used to it.
“I still think the guidelines [which are up for reauthorization next month] are necessary,” she said. “We have a childhood obesity epidemic and the guidelines were put in place to address it. … A little bit of waste at the get go may be a sacrifice we have to make for the health and well being of children in the long term.”
Amin added that the guidelines need to be supplemented with other strategies both in the school cafeteria and at home. Those strategies range from serving veggies with dip, cutting fruits up into smaller chunks and, more broadly, incorporating farm-to-school programs into the curriculum.
For more positive school meal ideas, Amin pointed to the website School Meals That Rock, which depicts images of beautiful, healthy school meals, debunks myths and, in general, tries to show that school meals can be cool and delicious.
Here’s more from the UVM news release:
Less than a month before Congress votes on whether to reauthorize a controversial program mandating healthier school lunches, a new study confirms the suspicions of school officials – many students are putting the fruits and vegetables they’re now required to take straight into the trash, consuming fewer than they did before the law took effect.
The new study…is also one of the first to compare fruit and vegetable consumption before and after the controversial legislation – the Healthy, Hunger-Free Kids Act of 2010 – was passed.
After passage of the legislation and the USDA mandates it put in place 2012, the study found that students put more fruits and vegetables on their trays, as required, but consumed fewer of them and increased waste by approximately 56 percent.
“The basic question we wanted to explore was: does requiring a child to select a fruit or vegetable actually correspond with consumption,” says Sarah Amin, Ph.D.
“The answer was clearly no,” she said…
Digital imaging produces fast, accurate data
Amin and her co-authors documented almost 500 tray observations over 10 visits to two elementary schools in the Northeast before implementation of the USDA guideline and almost twice as many observations afterwards.
Forty to 60 percent percent of the students at the schools qualified for free or reduced lunch, a marker for low socioeconomic status.
The research team used a digital imaging method that they validated three years ago in the Journal of the Academy of Nutrition and Dietetics to measure consumption.
The new methodology, which involved visual estimations and calculations based on digital photographs of trays as students reached the cashier and again after they passed the food disposal area, was faster and more accurate than conventional methodologies that simply weighed food waste.
“The beauty of this method is that you have the data to store and code to indicate what was selected, what was consumed, and what was wasted as opposed to weighed plate waste, where everything needs to be done on site,” said Amin, who hopes to develop an online training tutorial that could be used by schools across the country to measure consumption and waste.
Revisiting past practices part of answer to increasing consumption
In an earlier study published in the Journal of Child Nutrition and Management, Amin and colleagues looked at what types of fruits and vegetables children selected prior to the new guideline.
They found that children preferred processed fruits and vegetables such as the tomato paste on pizza or 100 percent fruit juice rather than whole varieties.
In addition to making sure those options are available, Amin and her colleagues offer these additional strategies in the paper for increasing fruit and vegetable consumption in school lunch programs:
- Cutting up vegetables and serving them with dip or mixing them in with other parts of the meal;
- Slicing fruits like oranges or apples, rather than serving them whole;
- Adopting promising strategies targeting school settings such as Farm-to-School programs and school gardens, which can encourage fruit and vegetable consumption in addition to what the cafeteria is providing
- Putting public health programs in place that encourage fruit and vegetable consumption in the home, which could carry over to school.
The report summarizes the legal status of khat (Catha edulis, also known as kat, qat, chat, and miraa), a plant whose leaves have a stimulant effect when chewed, in seven jurisdictions. It includes information regarding the legality of khat in each jurisdiction and, where it is banned, the applicable penalties. According to applicable tax laws or secondary sources, khat appears to be legal in Djibouti, Ethiopia, Kenya, Somalia, and Yemen, but is banned in Jordan. Its status in Turkey, where it is categorized as a controlled substance, is unclear. Whereas it is legal under Turkish law to produce, sell, import, and export khat with a license, it appears that consumption of the substance is banned.
Visit http://www.loc.gov/law/help/legal-status-of-khat/index.php to read the entire report.
This report is one of many prepared by the Law Library of Congress available at http://loc.gov/law/help/legal-reports.php and one of the new reports highlighted at http://www.loc.gov/law/help/current-topics.php. The Law Library of Congress produces reports for members of Congress and others. Learn more at http://blogs.loc.gov/law/2013/05/law-library-provides-global-legal-research/.
This report summarizes inheritance law in the 19th and 20th centuries in France, Germany, and the United States. French law of the period reflected the egalitarian system of inheritance brought about by the French Revolution, even after reforms instituted by the Napoleonic Code. Nineteenth-century German law was splintered into territorial regimes characterized by differentiated succession rules for the nobility versus the peasantry--a distinction that continued to some extent even after the unified German Civil Code became effective in 1900. Early inheritance law in the United States, premised on English law, was a matter of state law (as it is today) and thus varied, but during the period in question became much more egalitarian with regard to the inheritance rights of women.
A bibliography of English Inheritance Laws in the 19th and 20th Centuries is also included.
Visit http://www.loc.gov/law/help/inheritance-laws/index.php to read the entire report.
This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php. The Law Library of Congress produces reports for members of Congress and others. Learn more at http://blogs.loc.gov/law/2013/05/law-library-provides-global-legal-research/.
Today’s interview is with Noah Lapidus. Noah has been working on the Indigenous Law Portal for several months as an LC Knowledge Navigators Intern. We have previously written about the Indigenous Law Portal several times, including an introduction to the Portal and our addition of Alaskan and Canadian indigenous laws to the portal.
Describe your background.
I was born and raised in beautiful Birmingham, Alabama. Two years ago I moved to Boston, where I study International Relations at Northeastern University. I spent my first semester in London, and then after a year in Boston, I relocated to Washington DC, where for the past six months I’ve had the pleasure of interning at the Law Library in the mornings and for Senator Warren in the afternoons. I will return to Boston to complete my sophomore year this fall after returning to Birmingham for the summer.
How would you describe your job to other people?
I work directly under Dr. Jolande Goldberg, the Law Library classification (K class) expert whom I am now happy to also call my mentor and very close friend. Dr. Goldberg’s most recent efforts have been towards developing the classification schedule for a field that has been too long ignored–Indigenous Law (Class KI). Dr. Goldberg also recognized the potential utility for making such a resource available on the web, and pursued just that.
The Indigenous Law Portal is a free and interactive tool, accessible through the Law Library’s website and based on the new and developing schedule, which seeks to provide unrestricted access to the vast collections that both the Law Library and the Internet have to offer in regards to indigenous law. My job has been to collect the documentation (bylaws, treaties, constitutions etc.) of the various tribes, tribal councils and advocacy organizations found in Dr. Goldberg’s classification. During my time at the Library, I have focused on collecting documents from both Canada and Mexico. I was preceded and will be succeeded by groups of interns who will continue to make impressive strides in other countries. Indigenous law plays a vital role in the quest for indigenous rights, and never before has it been so easily accessible and neatly organized in a singular database for all of the Americas– and hopefully one day, for the entire world.
Why did you want to work at the Law Library of Congress?
Personal fulfillment is a prerequisite for any position I apply for, and with this project I saw just that. Obviously I am thrilled to be participating in the development of such an important tool related to indigenous rights, but simultaneously I am assisting in the revitalization of the classification system. Having never lived in a world without the Internet, the classification system has been largely irrelevant in my quest for knowledge. But little did I know, until the first day that I wandered into the library that “Classification is not the organization of books, but of knowledge” (Dr. Goldberg).
What is the most interesting fact you’ve learned about the Law Library?
Upon arrival I was amazed to learn how diverse and multicultural the staff at the Library is. I have learned so much from the people I work with–so many languages, so many backgrounds, and so many new great friends. It makes me wonder why I ever felt the need to travel the world. Next time I’ll just return to the Library of Congress.
What’s something most of your co-workers do not know about you?
I am an avid genealogist. I spent practically my entire childhood researching my genealogy and have been on multiple trips dedicated to researching my ancestry and meeting cousins. To say I’ve spent most of my free time researching in the various reading rooms (when not attending concerts sponsored by the American Folklife Center) would be an understatement.