Let’s Speak Up for Title X

Last month, the Department of Health and Human Services announced proposed changes to the rules governing the Title X program. Created in 1970, Title X is the only federally funded grant program exclusively dedicated to providing low-income patients, including adolescents, with essential family planning and preventive health services and information.

The Title X program is an important thread in the fabric of women’s health care. As the only federal grant program of its sort, Title X plays a vital role in ensuring that safe, timely, and evidence based care is available to every woman regardless of her financial circumstances.  However, the proposed changes fundamentally change the nature of the Title X program by restricting access to essential preventive care, interfering in the patient-physician relationship and making it harder for women to make timely, informed decisions about their care. These limitations and restrictions undermine our ability to offer patients medically accurate, comprehensive care.

As ob-gyns, we know the essential role contraception plays in our patients’ lives. Contraception is cost-effective, reduces unintended pregnancy and abortion rates, and allows women to have more control over their reproductive health. It also allows women and their families to achieve greater educational, financial, and professional success and stability. Title X plays an essential role in ensuring these choices are accessible to every woman. No patient should have to sacrifice safety or efficacy because no better options are available to her.

Moreover, Title X does not just address family planning needs, but also routine preventive care. Health centers that receive Title X funds also provide services like well woman exams, breast and cervical cancer screenings, screening and treatment for sexually transmitted infections, testing for HIV, pregnancy testing and counseling, and other patient education and/or health referrals.  These services save women’s lives.

The proposed changes also raise specific concerns about government interference in the practice of medicine. While Title X funds have never been permitted to be used for abortion care, the proposed changes take a further step to exclude qualified providers from participating in the Title X program. This puts access to essential care at risk for 40 percent of Title X’s four million patients.  ACOG opposes any effort to exclude qualified providers from federal programs.

We oppose political efforts to direct health care providers to withhold information or rely on non-evidence based counseling methods. We consider any effort to move away from science-based principles to be interference in the patient-physician relationship.  Women count on their providers for clear medical information. The government should not limit what information women can know or what kinds options she should be given.

This level of interference in the practice of medicine would set a dangerous precedent for all areas of medicine.

In practice, these changes will have the most profound impact on low income women and women of color, the very patients this program was created to serve. We cannot accept less access or fewer options for some patients simply by circumstances of their geography or finances.

Your voice can make a difference on this important issue. Over the course of the next few weeks, we will be asking you to engage in advocacy on this issue, including submitting comments. In July, ACOG  members will receive a sample comment template to use.

Thank you in advance for joining me in ensuring that women have continued access to high quality, medically accurate reproductive and preventative health care through Title X. It’s essential to women’s health.

Communities at Risk: Suicide Rates Rising Across the U.S.

The loss of Kate Spade and Anthony Bourdain last week is a reminder that depression and suicide can affect anyone.  There has been a 30% rise in suicide rates from 1999 to 2016, according to a report on released by the CDC on June 7, 2018. Suicide increased in almost every state, and killed more Americans ages 10 or older than homicides did nationally. CDC Principal Deputy Director Anne Schuchat noted, “Suicide is a leading cause of death for Americans – and it’s a tragedy for families and communities across the country.”

As physicians, we are not immune to the realities of suicide.  Physicians suffer from higher rates of burnout, depressive symptoms, and suicide risk than the general population. Suicide generally is caused by the convergence of multiple risk factors — the most common being untreated or inadequately managed mental health conditions.12

The suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced — 2.27 times greater than the general female population.3  According to one study, physicians who took their lives were less likely to be receiving mental health treatment compared with non-physicians who took their lives even though depression was found to be a significant risk factor at approximately the same rate in both groups.

What can you do? Know the signs and don’t be afraid to ask for help. As physicians we also need to take care of ourselves. Past ACOG President Dr. Mark De Francesco’s task force on physician wellness compiled several resources for ob-gyns to help cope with several issues such as adverse events and burnout. You can find additional resources here.

Ob-gyns also have a unique opportunity to play a pivotal in women’s mental health. ACOG recommends screening for depression at least once in the perinatal period. Visit ACOG’s resource overview on depression and postpartum depression for more information.

More recently, ACOG also released two new committee opinions pertinent to helping ob-gyns address mental health. In Committee Opinion 736: Optimizing Postpartum Care,ACOG emphasizes the importance of the fourth trimester. By increasing touch points with patients and asking questions, ob-gyns can better understand and assist new mothers. Committee Opinion 740: Gynecologic Care for Adolescents and Young Women with Eating Disorders highlights how the annual well women visit can serve as a women’s gateway to other health services, including mental health or behavioral health services.

Don’t underestimate the value of simply listening. If you know someone who might be suffering from suicidal thoughts, visit the National Suicide Prevention Lifeline or call 800-273-TALK.

At the Heart of Patient Care

More than 90 percent of women have at least one risk factor for heart disease, yet most women are unaware that heart disease is their leading cause of death in the United States.  Less than half (39%) of primary care physicians, including ob-gyns, consider cardiovascular disease to be a top concern for women.

Last month, ACOG and the American Health Association released a joint advisory calling on ob-gyns to use annual well woman exams as an opportunity to assess a woman’s risk for heart disease.  For many women, their ob-gyn is the only physician they see routinely, particularly women during their childbearing years. This emphasizes the important role of the ob-gyn to identify risk factors for heart disease and stroke—long before clinical signs are apparent.  Not doing so is a missed opportunity for early detection and intervention.

Research shows that pregnant women with complications like preeclampsia, gestational diabetes, and growth restricted babies, have three times the risk of later cardiovascular disease than women without these pregnancy complications.  Additionally, cardiovascular events and cardiomyopathy are the leading causes of maternal mortality in the U.S., together accounting for 25 percent of all maternal deaths.

As the leading health care providers for women, we can be a powerful voice for patients, counseling and educating them on how to achieve and maintain long-term heart health. Whether it’s advising patients about healthy diet and lifestyle, or taking advantage of high-tech solutions such as software algorithms that can trigger patient education and referrals by analyzing data contained in electronic medical records, the well woman exam is an opportunity for us to deliver patient-centered care.

I’m so excited to share more with you during my year in office, and to hear from you directly. Connect with me on twitter at @TXmommydoc.

Guest Blog: We Took AIM at Maternal Mortality and Made a Difference

No woman should die on what ought to be the happiest day of her life. Yet that is exactly what’s happening in the United States at a rate unmatched in the developed world. ProPublica-NPR recently highlighted the realities of maternal mortality in an article about a 36-year-old African-American mother—an epidemiologist at the Centers for Disease Control and Prevention—who died after giving birth from complications of high blood pressure.

The rates of maternal mortality in our home state of Michigan are stunning. There are 10.6 pregnancy-related deaths per 100,000 women, and African-American women die at a rate that is 4.9 times higher than white women. There are many causes of maternal death. The leading causes include heart attack or heart failure, stroke from high blood pressure, severe bleeding, serious infection, and blood clots. And, as more pregnant women have chronic health conditions such as obesity and heart disease, they become more likely to die during or after pregnancy. Even more startling is that, for every woman who dies, there are 100 more who suffer severe maternal morbidity—life-threatening injuries, infection, or disease due to chronic or acute conditions

Last month, the Alliance for Innovation for Maternal Health (AIM), a national initiative championed by 19 women’s health care organizations including ACOG, has already shown early steps toward reducing severe maternal morbidity. The goal of AIM is to reduce preventable maternal mortality and morbidity through hospital implementation of proactive patient safety bundles and resources for common pregnancy-related complications, such as preeclampsia and hemorrhage.

In 2015, Michigan became one of the first eight states to join AIM. ACOG’s Michigan Section teamed up with the Michigan Health & Hospital Association and the Michigan Department of Health & Human Services, along with the American College of Nurse Midwives and the Association of Women’s Health, Obstetrical and Neonatal Nurses to align resources and work cohesively as a single initiative for all birthing hospitals in the state. The initiative is called MIAM.

Roughly 80 hospitals in Michigan have committed to implementing the AIM safety bundles. They have also committed to collecting and reporting data on maternal outcomes to drive quality improvement. This reporting allows hospitals of similar size and capacity to assess and compare their performance and progress.

While this type of work requires a culture shift that will take time to fully adopt, we are already seeing dramatic improvements in maternal health. In Michigan alone, there has been a

  • 10.5 percent decrease in severe maternal morbidity since 2016
  • 17.9 percent decrease for other complications during labor and delivery among women who experience hemorrhage
  • Five percent decrease among women who experience hypertension

Recent data from four of the original eight AIM states, which collectively represent 266,717 births, also shows a marked difference in maternal outcomes. There has been a 20 percent decrease in the severe maternal morbidity rate.

Mother’s Day is a good reminder that we as health care providers must resolve to remain diligent in our efforts to reduce maternal mortality and morbidity. We commend each of our AIM hospitals and urge hospital administrators to stay focused on the task at hand: to provide the necessary support to make the AIM initiative a priority so we can succeed at keeping mothers safe.

For a long time, Michigan hasn’t been the safest place for moms—especially African-American moms—to give birth. The good news is that, over the past few years, the numbers have been finally going in the right direction. We are poised to continue making improvements and ensuring that every mom can safely give birth in Michigan, and every state in the country.

Written by ACOG Members Jody Jones, MD, and Matt Allswede, MD

We MUST Do Better on Maternal Health

The first time I saw a new mother die, I was early in my career. A healthy, young woman had a complication during labor and needed a C-section. While the care team delivered a healthy baby, the mother never regained consciousness and eventually passed away. I remember seeing her husband late that night in the hospital, holding his new baby. It was supposed to be the happiest moment of his life, but instead he looked completely lost.

That moment had a profound effect on me and is one of the reasons I’ve committed my career—and now my ACOG presidency—to reducing preventable maternal mortality. As I said last week at the 2018 ACOG Annual Meeting in Austin, Texas, where I was sworn in as the 69th president of ACOG, “To achieve our full potential not just as women, but as a country, and as a global community, the health of women MUST be a priority.”

As ob-gyns, we dedicate our lives to advancing women’s health, and there is no contradiction more stunning than the rise of maternal mortality and morbidity in the United States. While other countries have been able to reduce maternal deaths over the last 20 years, the U.S. continues to see rates grow. Worse yet, African American women are two to four times as likely to die from pregnancies than Caucasian women.

During my year as president, ACOG will continue its good work surrounding the issue of maternal mortality through three initiatives:

  1. Advocacy on the state and federal level to establish maternal mortality reviews. These state-based reviews offer a valuable opportunity to understand maternal death through a detailed review of medical records and autopsy reports. By finding causes of and contributing factors to maternal death, we can identify opportunities to prevent them.
  2.  A stronger culture of patient safety in hospitals. ACOG helped found the Alliance on Innovation on Maternal Health (AIM), a national maternal safety and quality improvement initiative to reduce maternal mortality and severe morbidity. Together with 19 partner women’s health care organizations, ACOG has worked with hospitals and health systems to implement patient safety bundles across the country. Today, 23 states are part of AIM, and it’s our goal to sign on all 50 states.
  3. A taskforce devoted to heart disease in pregnancy. Cardiovascular disease is the number one cause of death in women in the U.S. (400,000 deaths annually), and cardiovascular events and cardiomyopathy are the leading causes of maternal mortality, accounting for nearly 25 percent of deaths. This multidisciplinary taskforce will concentrate on creating evidence-based, best practice guidelines addressing screening for, diagnosis, and management of cardiovascular disease in women, before, during and after pregnancy. It will also address the pregnancy-related contributions to lifelong cardiovascular risk by evaluating the evidence, making recommendations, and prioritizing research that will drive better care.

While I’m excited to have this opportunity to focus on safe motherhood, one of the most enjoyable aspects of this position is to meet you, my fellow members. I look forward to working with you, and our new class of Fellows who took the oath last week, to provide the best clinical care to women of this country. Please connect with me on Twitter @TXmommydoc, and follow @acognews to keep up with the latest news in our profession.

A Look Back: A Year Spent Advocating for Women’s Health

Throughout my long career as an ob-gyn, I’ve never been witness to a more intense national focus on the health care provided to American women than I have in this past year as president of ACOG. We’ve seen the deaths of pregnant women during and after childbirth take center stage as our understanding of the embarrassing U.S. maternal mortality rate grew. Countless labor and delivery unit closures at rural hospitals across the country have drawn attention to access to care, and many were shocked to learn that nearly half of U.S. counties lack a practicing ob-gyn. Legislative attacks on women’s health care have spread like wildfire, as both federal and state governments have attempted to restrict women’s ability to obtain health coverage and contraception, obstruct their access to abortion care, and institute punitive measures for pregnant women suffering from drug addiction. From the beginning, it was clear that the challenges facing our specialty—and to us, the physicians who care for women throughout their lifespan—are immense.

Before I officially took the reins in May 2017, we were already in the midst of the work, advocating against efforts in Congress to strip health care from millions of women through the repeal of the Affordable Care Act (ACA). Women stood to lose access to no-copay contraception, affordable maternity care, and essential preventive services. Women were at risk of returning to a time where they might have been denied coverage based on a prior C-section or had to pay more for insurance based on their gender, and Medicaid coverage for hundreds of thousands of low-income women would have been in jeopardy.

All of this played out in the news as ACOG fought fiercely alongside five other provider organizations in a coalition called the Group of 6. We batted down every iteration of legislation that would have been detrimental to the health of the women in this country. We lobbied, we rallied, we spoke to the media, and we galvanized ACOG members in support of this common cause. I am proud of what we accomplished, and I count the tremendous effort to defeat ACA repeal as one of the successes of my presidency. But, of course, there was much more work to be done.

In addition to my time at ACOG, a large focus in my career has been on perinatal health disparities and maternal mortality. More than 60 percent of maternal deaths are preventable, and more than 65 percent occur within the first week postpartum. One way ACOG is trying to address this is through the Preventing the Maternal Deaths Act. It would provide grant funding to states to establish or bolster maternal mortality reviews committees tasked with studying the causes of these deaths, and how they can be prevented. But these statistics also indicate that as providers, we need to change the paradigm when it comes to postpartum care.

As part of my presidential task force, “Redefining the Postpartum Visit,” we began with the premise that postpartum care is the gateway to lifelong health. It is not sufficient for women to have one visit six weeks after childbirth. It is critical for women to be seen within the first three weeks and then on an ongoing basis as needed—up to 12 weeks—to address several issues, including breastfeeding complications, postpartum depression, and chronic conditions such as diabetes and heart disease that often persist long after pregnancy. Women have multiple intersecting health needs, so we must facilitate care coordination between multiple providers to ensure women are able to seamlessly access the support and care they need. The task force just released a Committee Opinion this week and, in the coming months, a companion online toolkit for providers will be developed to assist in providing more holistic care. The latest article from ProPublica outlines how this reinvention of postpartum care will require “sweeping” changes in medical practice and throughout the maternal care system if we are to truly optimize the health of moms.

Another focus of my presidency has been on innovation in technology to improve women’s health, particularly telehealth and telemedicine. According to a Health Affairs study, nine percent of rural counties experienced the loss of all hospital obstetric services between 2004 and 2014. Through my “Telehealth Task Force,” we have been working to develop best practices in ob-gyn to improve access and address fragmentation in care. This has significant implications for the Levels of Maternal Care initiative, which focuses specifically on care access in rural settings. It relies on communication and care coordination between hospitals and birthing centers so that women can be transferred to and receive care from a facility that offers the level of care that best suits their needs. Telemedicine will be key in fostering that communication.

The task force remains committed to addressing issues regarding safety, payment, experimental e-obstetrics, virtual education, video conferencing, virtual monitoring, apps, and the crossover between inpatient and outpatient care. In the future, a telehealth Committee Opinion will be developed, and an ongoing work group will be established to continue this important effort. We are also combating the access issue from a legislative perspective through the Improving Access to Maternity Care Act. It has been passed in the House and currently resides in the Senate. Through this legislation, an official maternal health designation through the Health Resources and Services Administration will be created to better determine shortage areas. This in turn will allow more providers to serve in these areas through loan forgiveness programs and scholarships offered by the National Health Service Corps.

However, in our efforts to improve care on a systematic basis, we must not forget how critical it is to address implicit biases that permeate every aspect of care delivery and contribute to the racial health disparities that have led to our high maternal mortality rate. An often-repeated statistic, is that black women in the United States are three or four times more likely to die during childbirth than white women. It is shocking to most, but it shouldn’t be. Racial health disparities have a long history, and events as recent as what happened in Charlottesville last year remind us we still have a long way to go.

Even when black women have access to health care and advanced education, they are still at a disadvantage when it comes to receiving the quality of care on par with their white counterparts, and the constant stressors of racism and racial biases often put them at higher risk for chronic health conditions. Cardiovascular disease disproportionately affects black women, and stress has been linked as a possible contributor. I have been working with Dr. Lisa Hollier, ACOG’s incoming president, to partner on initiatives with the American Heart Association to address issues with women and cardiovascular disease, and I am confident that she will make marked improvements in this area.

It has been a whirlwind. I have traveled the country and the world in pursuit of advancing women’s health and ensuring that the clock is not turned back. I have worked alongside ACOG leadership and Fellows, including my esteemed colleagues, Drs. Hollier and Gellhaus, to improve maternal health for all women in the United States and serve as a model for women’s health care throughout the world. It has been a rewarding journey, and we have made incredible progress, but I am ready to pass the torch, and wish Dr. Hollier success as she carries it forward—there is much more work to be done, and I look forward to working with her this year as immediate past president.

Advancing Women’s Health Care at Home and Abroad

Every year on March 8 we mark the occasion of International Women’s Day. For women’s health care providers, it creates an opportunity to reflect upon the patient population we serve, at home and the world. This year, to commemorate International Women’s Day, I’d like to celebrate ACOG’s recent successes in women’s health, while they are proud achievements to be sure, there is still significant work to be done to gain sustainable improvements around the globe.

ACOG is committed to leveraging the expertise and commitment of our Fellows to support women’s health programs around the world through the Office of Global Women’s Health (OGWH). Our mission is to increase women’s access to quality health care:

  • by building provider skills,
  • supporting implementation of high impact interventions,
  • and scaling proven solutions to decrease maternal mortality and morbidity.

OGWH has a portfolio of programs in 11 countries, including Malawi, Uganda, Rwanda, Ethiopia, the Dominican Republic, El Salvador, Guatemala, Honduras, and more. While our work in each country is unique, it’s guided by a shared set of goals.

It would take a great many pages to provide a detailed overview of all OGWH’s efforts, but I’ll share two success stories from different parts of the globe.

In Malawi, ACOG implemented a demonstration project based on the Alliance for Innovation on Maternal Health. Together with the Malawi Ministry of Health and Baylor College of Medicine, ACOG tailored post-partum hemorrhage (PPH) bundles to improve recognition and management of obstetric complications. Hundreds of local hospital staff were trained in team communication and PPH management, and prepared for implementation of the bundles. The program reduced incidences of maternal hemorrhage and increased lifesaving interventions from 3.7 percent to 34.4 percent for patients who had uterine atony after delivery.

In Central America, ACOG works to enhance professional education and training standards through the Central American Residency Program. Our efforts support development of residency accreditation and administration of in-service exams, establishment of minimal educational standards, quality assurance processes and mentorship of hospital leaders. Over time, we’ve built very strong relationships and now engage with 75 percent of all ob-gyn residency programs in Central America.

These are just two snapshots of OGWH’s work to advance women’s health across the globe, but they help to illustrate the breadth of opportunity – from preventing maternal deaths to raising the standard of medical practice. As women’s health care providers, we must continue to work together with our colleagues near and far to build a health care system that serves every woman’s needs. In addition to the programs outlined above, ACOG annually hosts a meeting of academic ob-gyn from across the globe to ensure a continuous exchange of knowledge and experience sharing.

ACOG has a unique platform to share knowledge and resources to improve the delivery of care globally. If you’re interested in learning more about how to become involved with these opportunities, visit www.acog.org/ogwh.

How Dedication to Black Maternal Health Honors the Legacy of Henrietta Lacks

Sixty-seven years ago, two tissue samples taken from a young, African-American woman diagnosed with cervical cancer led to the most important cell lines in medical research. Her name was, of course, Henrietta Lacks. Today, it would be difficult to find someone who isn’t familiar with her story. The “immortal” He-La cells have been used in more than 74,000 studies and have led to the discovery of the Polio and HPV vaccines, treatments for diseases, including diabetes and AIDS and other life-saving research around the world.

The contributions Lacks made to medical science have been heralded in the best-selling book, “The Immortal Life of Henrietta Lacks,” by the foundation created in her name, in countless news stories, in an HBO movie starring Oprah Winfrey and by the National Institutes of Health (NIH) through the establishment of a working group in her honor. In 2013, the NIH stated that Lacks and her family were the “greatest philanthropists of our time.” However, it wouldn’t be until 1987, 36 years after her cells were replicated and shared widely amongst the research community, that the NIH would institute a policy “encouraging” the inclusion of minorities in clinical studies. And it would be another six years before Congress would make it law through a section in the NIH Revitalization Act of 1993 entitled Women and Minorities as Subjects in Clinical Research. The reason for this move by the NIH is obvious. We cannot appropriately evaluate the effects of drugs in clinical trials without a racially diverse sample.

Therefore, it should be considered one of the greatest conundrums of our time that a black woman is responsible for thousands of breakthroughs in biomedical research and yet, in 2018, black women are three or four times more likely to die during childbirth than their white counterparts. When it was discovered that Lacks had cervical cancer, she had just given birth to her fifth child. At 31 years of age, Lacks suffered from a severe hemorrhage after childbirth and died eight months later after receiving routine cancer treatments and experiencing continued abdominal pain.

By today’s definition, Lacks would be counted among the women lost to maternal mortality. According to the Health Resources and Services Administration, the maternal mortality rate in the 1950s was 83.3 deaths per 100,000 live births. And while that number has decreased significantly since then, it is well-known that the United States is considered one of the most medically advanced developed countries— and yet, it has the highest maternal mortality rate amongst its peers, with even higher numbers for minority women.

I’ve done several media interviews on the topic of racial disparities in maternal mortality. Reporters always ask why these disparities exist, especially among well-educated, affluent black women where access to care is not an issue. In my interview with Essence magazine, I explain that there is a complex web of causes, but it often involves social determinants of health and structural barriers to health care. Whether an African-American woman is rich or poor, has a GED or a PhD, she is susceptible to morbidity and mortality and implicit biases of race and class. This not only impacts the quality of care she receives, but can also have negative physiological effects. The relationship between stress and how we respond to that stress physiologically has well-documented associations with prematurity and cardiovascular disease. The “microaggressions” that black women endure throughout their lives also make them predisposed to chronic conditions that can make a pregnancy high risk, such as hypertension and diabetes. It is a failure in our medical care as providers if we do not 1) recognize and accept this and 2) meet the necessary cultural and systemic challenges that impact health outcomes.

During my ACOG presidency, much of my focus has been on providing guidance on how to make these system level changes. In May, ACOG will release a revised “Optimizing Postpartum Care” Committee Opinion developed by my presidential task force, “Redefining the Postpartum Visit,” and the Committee on Obstetric Practice. It will stress the importance of the fourth trimester and propose a new paradigm for postpartum care. When women fail to receive postpartum care, it impedes management of chronic health conditions. Attendance rates are often lower among populations with limited resources, which contributes to health disparities.

As we celebrate Black History Month and the contributions of African-American mothers like Henrietta Lacks, we must honor her legacy by not accepting the deaths of black women from pregnancy and childbirth as a reality of race.

Putting Preventive Care Front and Center

ACOG has long been dedicated to the advancement of women’s health care, with particular focus on ensuring every woman has access to care in a safe, timely and affordable fashion. Over the last five years, this has included a dedicated effort to guarantee women coverage for the full range of necessary preventive services without additional out of pocket costs. Just five years ago, Dr. Jeanne Conry set this work in motion with her presidential initiative, Every Woman, Every Time. In the time since, we’re proud to say we’ve accomplished a lot, from generating new clinical guidance to support ob-gyns in the delivery of comprehensive care to advocating on behalf of women everywhere to protect their coverage.

Today, we’re marking the continuation of that progress with the launch of CareWomenDeserve.org, a campaign that brings together women’s health leaders to increase patients’ knowledge about covered preventive health services available. This project calls upon the Women’s Preventive Services Initiative, an ACOG led program that, since 2016, has focused on developing, reviewing, and updating recommendations for women’s preventive healthcare services, including HRSA-sponsored Women’s Preventive Services Guidelines.

Though the Affordable Care Act requires the coverage of these vital preventive health services for women, too many of our patients are unaware of the benefits available to them with no additional out of pocket costs. The services covered include annual well-woman visits, cervical and breast cancer screenings, breastfeeding support, contraceptive coverage and counseling, domestic violence screening and counseling, STI screening and counseling, and screening for gestational diabetes; and just recently it was announced this list would be expanded to include post-partum screening for diabetes and screening for urinary incontinence, beginning in 2019.

I do not have to impress upon you the importance of each of these services to helping our patients maintain healthy lives. When our patients receive proper, comprehensive preventive care they are less likely to suffer from undiagnosed or untreated conditions, and when they want to become pregnant, they have healthier pregnancies and births, that lead to healthier children.

Our role many times is to help our patients to first access care, and then to help them plan for what comprehensive care looks like for them at every age. For many women, this includes helping them navigate the health care system and identifying the care that’s already covered and available to them. CareWomenDeserve.org provides numerous resources that clearly identify covered preventive health services, and why they’re important to women – including young women who may feel that because they’re presently healthy they don’t need to come in for routine care!

We’re excited about this new campaign, and the part it will play in continuing to advance women’s health care. In the coming months, we hope to also expand this effort to include resources for providers to share in their offices to help increase patient awareness. Likewise, we’ll continue our parallel work and leadership on WPSI, to make sure the most up to date and evidence based content is available to women’s health care providers everywhere. In the meantime, let’s all commit to ensuring every patient gets the care she needs, when she needs it.

For more information about ACOG’s leadership on WPSI, please visit: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Womens-Preventive-Services-Initiative

 

4 Simple Steps Ob-Gyns Can Take to Increase Flu Vaccination Rates Among Pregnant Women

Recently, the Centers for Disease Control and Prevention (CDC) released data indicating that about two-thirds of pregnant women have not been vaccinated against the flu this season. As clinicians, we know that the flu shot is safe, effective and the best protection our patients have against influenza. It is our job to communicate these messages to all of our patients, especially pregnant women.

The flu vaccine is safe and recommended during all trimesters of pregnancy, especially the second and third trimesters, when there is an increased risk of severe disease, hospitalization and even death as a result of contracting the flu. By getting vaccinated, pregnant women can protect themselves while also providing protection to their babies through placental antibody transfer until they are able to be vaccinated at six months of age.

Despite the benefits of vaccination, the latest CDC data shows us that low vaccination rates among pregnant women are pervasive. They are not just low among all age groups, but also among women of different races and ethnicities, across all education levels and regardless of whether women have health insurance or not. Among white, black and Hispanic women, the vaccination rate is 35.9, 31.5 and 35.4 percent, respectively. Also, while roughly 39.1 percent of pregnant women with a college degree were vaccinated, that is only 4.4 percent higher than women with a high school education or less.

However, one interesting data point indicates that flu vaccination is highest among women who reported that their doctor offered or recommended the vaccine. Among women who visited a health care provider at least once since July 2017, 52.4 percent received the flu vaccine from a provider who offered it. Also, according to the data, 50.1 percent of pregnant respondents received their vaccination at their ob-gyn’s office, which far surpassed other locations, including other doctor’s offices (29.2 percent); the drugstore, supermarket or pharmacy (10.3 percent); and work or school (5.9 percent).

This indicates that we, as ob-gyns, have a lot more influence over our patients than we think we do and that they trust us when we counsel them on their health and well-being. By simply educating women about the benefits and recommending the vaccine or offering them the opportunity to get vaccinated, we have the power to increase vaccination rates among pregnant women in this country.

Four steps you can take today:

1. Educate all pregnant women about the flu vaccine and the severity of influenza disease.

2. Strongly recommend and offer flu shots to all patients in your practice, particularly pregnant women. Flu shots can and should be given as soon as the vaccine is available.

3. Document flu conversations and flu vaccine administration in your patients’ chart and, when possible, your state’s immunization information system.

4. Lead by example—educate and vaccinate yourself and your staff against influenza.

For more information and updates on the 2017-18 flu season, visit http://immunizationforwomen.org/2017-2018-influenza-season and http://immunizationforwomen.org/fluseasonnewsletter.