Our Moral Values, Our Core Values

It’s an interesting time for women’s health care, to say the least. With the recent passage of the American Health Care Act by the U.S. House of Representatives, obstetrician-gynecologists are faced with an uncertain political future. You may have the same questions that I do. Will this impact the way we practice and how we provide the best care for our patients?

As I took the reins as the 68th President of The American College of Obstetricians and Gynecologists last week, I discussed the importance of the Hippocratic Oath, one of the oldest binding commitments in history. Building from the central premise to ‘first do no harm,’ it outlines our responsibilities and obligations as ob-gyns to provide the best evidence-based care to all of our patients. These are our moral values, our core values and as women’s health care provides we have long demonstrated the passion and compassion in the clinical care of our patients.

At medical school graduations and hooding ceremonies at Duke University and many other institutions, all physicians in attendance have the opportunity to reaffirm and recite the Hippocratic Oath with the graduating medical school class. It’s a great reminder of why we do what we do:

“I will apply for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.”

“My responsibilities include those related problems, if I am to care adequately for the sick.”

Regardless of the political climate, I urge you to remember that we are ACOG: the primary advocate for women’s health care. We cannot waiver on our position on key issues including the primacy of patient welfare, patient autonomy and social justice. These values address our societal contract as physicians; considering the available resources and needs of all while taking care of the individual.

We have many challenges ahead and hurdles to overcome especially in regard to access and affordability of essential benefits for pregnancy care and age appropriate preventative well woman’s screenings. However, we must remain steadfast in our commitment to women’s health care. I look forward to working with you, my colleagues, and our new Fellows who took the oath last week to provide the best clinical care to women of this country.

A Rewarding Journey as ACOG’s President

When I started my term as ACOG’s 67th president last May, I wanted to make a difference in the lives of our members and patients, ensure ACOG’s continued growth, and lift our voice as the leading specialty organization in the nation. In many ways, what we have accomplished in 12 short months has far surpassed my expectations given the complexity of the issues we’ve had to deal with and the extraordinary circumstances we’ve had to navigate and overcome. So, in my last month, I’d like to revisit some of the things that have made this such an impactful year and taken me around the globe.

When I initially laid out my priorities for advocacy and global women’s health, there was no way to know the challenges we would face to protect women’s continued access to reproductive and maternal health care, both domestically and abroad. As my tenure progressed and new challenges presented themselves, increased member engagement became even more essential. So, we leveraged my All-in for Advocacy campaign, an effort to amplify and expand our voice with state and federal policy makers through our member stakeholders. In 2016 and 2017, I traveled throughout the country doing presentations at Grand Rounds and participating in state lobby days and was wowed by the energy and eagerness of our advocates to make positive changes in their home states.  Physicians led efforts to support our patients and our practices, successfully advancing legislation from maternal mortality to Zika and defeating legislation affecting the sacred patient-physician relationship and restricting reproductive health rights.

Also, because of ACOG’s excellent government relations team, we launched the State Legislative Action Center, where ob-gyns are able to learn more about their legislature and elected officials, search active legislation, and find opportunities to take action. And this certainly was the year for action! Ob-gyns had an important voice in the discussions on health care reform and urged policy makers not to turn back the clock on women’s health by repealing the Affordable Care Act. We fought for our patients to have continued access to affordable insurance coverage, comprehensive maternity care, no-cost preventive services such as contraceptives, and consumer protections that would prohibit insurers from denying coverage based on pre-existing conditions or setting annual or lifetime benefit caps. And while the fight is not over, the defeat of the American Health Care Act this past March is evidence that we made a tremendous impact.

We have also made great strides in ACOG’s efforts overseas. Through my own personal work to advance health care in struggling countries, I learned that we as ob-gyns can make a difference in global women’s health by sharing our knowledge and resources. However, extended time away from one’s practice is always very difficult and, for some, next to impossible. One of my goals was to make short-term projects easily accessible and identifiable for ACOG members and I am proud to say that we developed a database of non-profit organizations involved in two-week mission work that allows ob-gyns to get more information and sign up.

We’ve also grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States. Through the hard work of ACOG’s Office of Global Women’s Health, the AIM safety bundle for postpartum hemorrhage has been instituted into practice in a low resource setting in Malawi at a community health clinic and referral hospital.  And it has meant so much to me to see the progress made and the lives saved because of this initiative. Additionally, ACOG helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology through several programs, including Health Volunteers Overseas. I’m particularly proud of this work because I firmly believe that the same high standards we have for health care in the United States are the same standards that should apply to other developing countries around the world.

Lastly, another one of my goals this past year was to continue efforts to address the workforce and practice pattern changes we’ve seen in our specialty by improving ob-gyn resident education models. In 2016, the Council on Resident Education in Obstetrics and Gynecology Education Committee embarked on a complete overhaul of the learning objectives for residents. This effort resulted in the release of the Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 11th edition. We are now surveying mid-career practicing ob-gyns to determine which of the core objectives they actually apply in their practices. Although this was an issue without an easy solution, we must continue to work together and discover ways to improve. And I truly appreciate all the hard work of ACOG’s education staff in helping to facilitate this endeavor.

As I pen my last blog, I feel that my time from president-elect nominee to president has been an incredibly rewarding journey that has literally spanned 400,000 miles, according to my frequent flier program. From trips to the nation’s capital to residencies across the country to small community health centers in Africa, each experience taught me so much and it was a great honor to be able to serve ACOG’s members in the process. If I had to impart any advice to ACOG’s incoming president, Dr. Haywood Brown, it would be to enjoy it because it will fly by. (No pun intended.) Enjoy the year, enjoy the people, and listen to their stories. Everyone has a story!

Conversations with Pregnant Patients Should Include Discussions About Infant Immunization Plans

This week is National Infant Immunization Week (NIIW), a time devoted to promoting the benefits of vaccination and to improve the health of children two years old or younger. As ob-gyns our active role in a baby’s health care often ends once a mother is discharged following delivery, but we play an important role in preparing women to tend to their infant child’s needs, including planning for immunization.

Pregnant women and infants are among the most vulnerable during infectious disease outbreaks. I’ve written before about ob-gyns responsibility to educate women about getting vaccinated during pregnancy, underscoring that immunization is essential to the health of both mother and fetus. Building women’s awareness about the importance of immunization during pregnancy also opens the door to discuss the importance of continuing immunization efforts into infancy and onward.

The positive outcomes associated with immunizing infants cannot be overstated. Though it’s hard for many to recall, there was a time where many infants and young children faced high risk of life threatening and debilitating illnesses. Many of these, like measles and polio, have been greatly reduced, almost eliminated due to population wide vaccination. We can protect children under the age of two from 14 different diseases, which is estimated to prevent 20 million cases of disease and about 42,000 deaths. While we should be heartened by these positive numbers, the key to keeping these infectious diseases at bay is ensuring parents understand that vaccination is safe and essential to the health of every child.

NIIW is a great time to renew efforts to educate patients about vaccine preventable diseases, and the positive impact vaccination has on all our lives. To make following immunization guidelines as straight forward as possible, ACOG has compiled all our immunization guidelines on one page, available here. Additionally, during a woman’s pregnancy, ob-gyns should encourage thinking about and planning for the infant’s health care. We can help by making referrals to pediatricians and directing women to resources that outline an infant’s necessary care, including immunization. The CDC prepares immunization schedules by age as a quick and helpful resource for providers, and childhood immunization schedule generators for parents, from age 0 to 6.

We are fortunate to live in a time where vaccination protects from some of history’s most devastating infectious diseases. We must continue to educate and support patients’ understanding about the overwhelming benefits of immunization for themselves and their children.

 

This Earth Day be a Champion for Environmental Science

Did you know that doctors are among the most trusted professionals in this country, specifically with regard to information about climate change? Environmental factors are hurting the health of millions of Americans every day and yet there is still a considerable lack of awareness about the harmful effects of things like extreme weather events, air pollution and other toxins.

As Earth Day approaches, it seems fitting that this year’s campaign is focused on environmental and climate literacy because it reminds us as ob-gyns how important it is for us to participate in the effort by leveraging the trust our patients have in us.  Our partner organization, the International Federation of Gynecology and Obstetrics, has kicked off the week by launching a social media awareness campaign around Earth Day.  You can follow them on Twitter under the handle @FIGOHQ.

Last month, I spoke at the launch of the Medical Society Consortium on Climate Change and Health that has brought together ten associations representing nearly 500,000 physicians, including ACOG, to help increase awareness among the public and policymakers about the negative health effects of climate change on Americans. During my talk, I spoke about the fact that women face some of the greatest risks from climate change over the course of their lives, and especially during pregnancy. In affected regions, climate change puts women at risk of disease, malnutrition, poor mental health, lack of reproductive control, and even death. Additionally, women’s exposure to toxic environmental agents during the preconception and prenatal stages can have a profound and lasting effect on obstetrical and later life outcomes, including increased risk of birth defects and childhood cancer.

In 2016, ACOG adopted a policy which recognizes that climate change is an urgent women’s health concern and a major public health challenge endangering fetal health. In fact, we discover new evidence every day of how it can disturb fetal development. A recent NIH study found that exposure to extreme hot and cold temperatures during pregnancy leads to increased risk of low birth weight in infants.

While the connection between climate change and women’s health may not at first seem obvious, there are a number of ways it directly impacts women’s health.  You can look at them in several categories: a healthy pregnancy starts with clean air, clean water, no toxic chemicals, and stable climate.

Air pollution poses serious risks for women’s health.  It is linked to pregnancy loss, low birth weight babies, and preterm delivery.  Fine particle air pollution affects the placenta in pregnancy, and can interfere with fetal brain development.  Ambient and household air pollution result in 7 million deaths globally per year; these effects are worse in low-resource areas.

Heavy downpours and flooding mixed with high temperatures can spread bacteria, viruses, and chemicals that lead to contaminated food and water. This results in higher levels of methylmercury in fish and shellfish, a known cause of birth defects.

Increased use of pesticides can interfere with the developmental stages of female reproductive functions, including puberty, menstruation and ovulation, menopause, fertility, and the ability to reproduce multiple offspring. These toxic exposures also affect fetal brain development, and contribute to learning, behavioral, or intellectual impairment, as well as neurodevelopmental disorders such as ADHD and autism spectrum disorder.

Extreme temperatures have fostered increases in the number and geographic range of insects. For example, Zika-carrying mosquitos have led to more than 1,500 infections in pregnant women across the United States and District of Columbia, and more than 3,200 infections in Puerto Rico and U.S. territories. Furthermore, extreme heat during pregnancy is tied to a 31 percent increase in low birthweight babies less than 5.5 pounds.

Unfortunately, in many cases, underserved and vulnerable populations are disproportionately affected by climate change. This includes individuals living in poverty, exposed to toxic materials via their occupation, who lack nutritious food, and live in low quality housing. That’s why access to health care is so critical.

We don’t all have to be experts in environmental science, but we all need to support rigorous scientific investigation into the effects of climate change and toxic environmental agents. With evidence to support us, ob-gyns must be the authoritative voice and help to ensure that the discussion on climate change includes protecting the health and safety of all women and children.

This blog post was co-authored by Nathaniel DeNicola, MD, MSHP, the ACOG liaison to the American Academy of Pediatrics Executive Council on Environmental Health, and social media director for the International Federation of Gynecology and Obstetrics Working Group on Reproductive and Developmental Environmental Health.

Four Ways ACOG Has Impacted Global Women’s Health in Just the Past Year

In 1994, my wife and I arrived for our first two-week mission in the Dominican Republic and were stunned by the line of people waiting outside of the hospital for us. Since medical school more than a decade earlier, we had dreamed of participating in mission projects around the world to help women in dire need of basic medical care. But then my wife began her career as a nurse, we started our family, and after residency I went into private practice. So, that goal went by the wayside. However, our trip to the Dominican Republic quickly reignited our hopes of providing necessary ob-gyn services in low resource settings. Living in the United States, it’s easy to forget that many countries around the world are battling poverty and disease and don’t have the same infrastructure and safety nets we do. After that first trip, I came home to a fully equipped operating room with the proper tools and lights that worked, my wife didn’t have to hold a flashlight during surgery because the power was out. We had carpeting and hot water at home. From that point on, my eyes were opened.

Since that first trip, I’ve continued to travel and offer my services to advance health care in struggling countries. This work has taught me that we can really make a difference in global women’s health by sharing our knowledge and resources as ob-gyns. As my presidential term at ACOG comes to a close, it is an appropriate time to reflect on what we have accomplished from my six-point plan, developed over a year ago, to help improve the health of women and children worldwide, with a focus on training and providing health care around the world.

The first step was to make these kinds of missions more easily identified and attainable. While it’s often not realistic to leave your practice for months; two weeks is doable. That’s why we developed a listing or database of non-profit organizations involved in two-week mission work in which some of our members had participated. Now on the ACOG website there is a global health resource center. ACOG members can discover more information about each organization, check these organizations’ calendars for potential projects, talk with ACOG fellows and junior fellows who have done projects, and sign up. And we must continue to get the word out so more members use and add to the database.

In partnership with the U.S. Department of Health and Human Services, we’ve also formed and grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States and now Malawi. Women living in rural areas of Malawi give birth at community health centers that can’t perform operative vaginal deliveries or C-sections. When these situations arise or other complications occur, women are transferred to the central hospital in the city, most often without any attempts at stabilization prior to transport. They are often in poor condition when they arrive, which results in many otherwise preventable maternal deaths. The AIM postpartum hemorrhage bundle has been instituted into practice at both the community health clinic and referral hospital. To date, more than 130 local people have participated in vital simulations to help these patients. And while we do not have formal data on the program yet, we know that several women have received life-saving care because the teams were able to communicate and execute care in a way that they didn’t before. We anticipate many more successes that will hopefully mirror the kinds of gains we have seen here in the United States.

In addition, last year ACOG partnered with Health Volunteers Overseas, a nonprofit group that helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology. It begins with local providers telling us what they need and then we come up with a plan and work together to make it happen. As of today, we have completed four site assessments and will begin offering global service opportunities for fellows in the four countries by May 2017.

Lastly, in Ethiopia, we received a five-year grant to develop a plan in partnership with the Ethiopian Society of Obstetricians and Gynecologists to strengthen their ob-gyn residency training programs and curriculum, improve continuing medical education, support the publishing and accessibility of clinical outcomes research, and develop an ob-gyn examination and certification program. Since its inception, the program has made great strides by working “shoulder-to-shoulder” with the Ethiopians. As a result of this program, there is now interest from other African countries to begin the same program.

The bottom line is, many women around the world are lacking access to quality, evidence-based health care and they are paying the price with their lives. As ob-gyns, we have the power to prevent this by using our skills to help reduce global maternal morbidity and mortality, as well as improved quality of life. These programs are a prime example of how we can achieve that by dedicating some of our time and effort to a cause that is greater than ourselves. While we’ve accomplished a lot, we still have much to do. So, even if you aren’t sure you have the time, consider any way you can contribute. Believe me, it will make a difference.

It’s Time We Talk About Endometriosis

Endometriosis—when the uterine lining grows outside of the uterus, resulting in severe pain, swelling and bleeding—is thought to affect more than 11 percent of all American women between the ages of 15 and 44. This condition impacts 6.5 million U.S. women, and 176 million women worldwide. Yet, it is still not easily recognized. It takes about 10 years from when women experience their first symptoms to receive an endometriosis diagnosis—half that time to recognize and bring up symptoms to a doctor and the other half for the doctor to diagnose it. For Endometriosis Awareness Month this March, we as obstetrician-gynecologists must do our part to raise awareness about the condition with our patients, strive to improve our understanding of the disease, and ensure more timely and accurate diagnoses.

Improving awareness and timely diagnosis of endometriosis helps women avoid unnecessary pain, and decrease infertility rates. Around 40 percent of all women with infertility have endometriosis and, of women diagnosed with endometriosis, about 40 percent experience fertility challenges. Many women struggling with infertility remain undiagnosed; others won’t be diagnosed with endometriosis until they start to experience problems conceiving. It falls to ob-gyns to reverse this trend, particularly as 63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.

Early endometriosis diagnosis and treatment lead to better outcomes. Careful listening and discussion are integral to early detection, as many common symptoms are not so obvious, such as chronic lower back pain and intestinal problems like diarrhea, constipation, bloating and nausea. We can also look for indicators that a woman is at greater risk of having endometriosis, including if she’s in her 30s and 40s; has a close relative who has been diagnosed with endometriosis (which increases risk by five to seven times); and has a higher body mass index (which is thought to promote the development of endometriosis because fat increases estrogen levels).

Raising awareness about endometriosis and increasing its timely diagnosis improves women’s lives. While symptoms may range in terms of severity, nearly all of them take a physical toll on a woman’s day-to-day life—from increasing tiredness to limiting her physical capabilities. It’s time to talk with our patients more regularly about endometriosis, and ensure more women are getting the care and support they need.

Ob-Gyns Can Be the Secret Weapon in the Fight Against Heart Disease

As ob-gyns, we know that the care we provide to women goes far beyond reproductive health. Thirty-five percent of women consider their ob-gyn their sole health care provider, putting us in a unique position to address an array of common health conditions. Since heart disease is the number one killer of women—and February is Heart Health Month—now is a good time to remember the part we can play in changing the outcomes of this devastating disease.

Perhaps the biggest threat of heart disease is lack of awareness of the condition’s prevalence and dangers. Though heart disease causes one in three deaths among American women every year—and 90 percent of women have at least one risk factor for developing heart disease—only one in five believes that heart disease is her greatest health threat, according to the American Heart Association (AHA). Equipped with these statistics, ob-gyns should feel confident initiating a conversation with patients about their heart health.

Helping patients address heart disease risk factors, ideally before a heart disease diagnosis, is key. Nearly two-thirds of women who die suddenly of coronary heart disease have no previous symptoms, according to the Centers for Disease Control and Prevention. For many women, the first signs of heart disease are actually the symptoms of a stroke, heart failure or heart attack, when serious damage may have already occurred. However, a number of risk factors are mostly under a patient’s control: an unhealthy diet and/or lack of exercise (both of which can lead to other important risk factors, including being overweight and having high blood pressure, high LDL cholesterol, and diabetes); smoking; and drinking to excess. When women are educated about how to make important lifestyle changes, it can be lifesaving. According to the AHA, 330 fewer women are dying from heart disease every day as a result of making heart healthy choices.

There are some factors that are out of a patient’s control, including a family history of heart disease, preterm labor and delivery, and preeclampsia. Ob-gyns can play an essential role by communicating the steps women can take to reduce their odds of a heart disease diagnosis. Even by simply acknowledging and discussing the risks, ob-gyns can make a difference. So, while these conversations aren’t always comfortable, they’re important because many women may not be hearing this information from any other health provider.

Lastly, since the symptoms of heart disease are widely misunderstood, particularly in women, it’s critical to share them with at-risk women. While angina is the most common symptom associated with heart disease, women are actually more likely to experience pain in the neck, jaw, throat, abdomen or back; shortness of breath; and nausea/vomiting. Lightheadedness, dizziness or fainting are common signs, as well. These symptoms don’t always occur during exercise or periods of stress; they can happen during rest, too. By ensuring your at-risk patients are aware of these signs, it could mean they get treatment faster, which will ultimately lead to better outcomes.

Ob-gyns have a powerful opportunity to be the secret weapon in the fight against heart disease. We can help inform our patients about the dangers, symptoms, and necessary preventative care. Communicated early and effectively, we can help women manage the factors that are in their control to help them live healthier, longer lives.

OB-GYN’s Crucial Role in Protecting Women from Cervical Cancer

Every year, more than 12,000 American women are diagnosed with cervical cancer, and more than 4,000 of those women die from the disease. And, according to a reevaluation of existing data in a study recently published in the journal Cancer, the cervical cancer death rate may actually be much higher than previously estimated. Since January is Cervical Cancer Awareness Month, now is an excellent time to educate our patients about the steps they can take to not become a part of these terrible statistics.

We know Pap smears are one of the most effective tools we have to improve cervical cancer outcomes. Half of all cases of cervical cancer occur in women between the ages of 35 and 55; it’s rarely found in women under 20, and about 20 percent of cases are in women 65 and older. That’s why we recommend regular cervical cancer screenings in our patients starting at the age of 21 and through the age of 65 or longer based on individual risk factors. Pap smears screen for a cancer that’s often symptomless, and they help spot changes in the cervix before cancer develops—when treatments are most effective. Due to widespread adherence to Pap smear testing, deaths from cervical cancer have decreased by 50 percent over the last 30 years. So, encourage your patients to attend their annual well-woman visits. Along with the opportunity to offer Pap smears and screenings, these visits provide an ideal occasion to educate patients about cervical cancer risks and prevention.

Of course, virtually all cervical cancer cases are linked to HPV. HPV is the most common sexually transmitted infection: 80 percent of all sexually active people will contract the virus in their lifetimes. A family history of cervical cancer increases the risk two- to three-fold, since these women may have a genetically inherited condition that makes it harder for their bodies to fight off HPV infection. The three-dose HPV vaccine protects against 81 percent of cervical cancer cases. The CDC, AAP, AAFP and ACOG all recommend the vaccine for boys and girls between the ages of 11 to 12 years old. Full vaccination reduces risk of certain HPV-related cancer by up to 99 percent; boosting vaccination rates could prevent 29,000 HPV-related cases of cervical cancer every year.

Vaccine adherence rates, however, remain low, with only about one-third of girls and just over one in 10 boys receiving their full vaccination series. Educating your young patients or those who are parents of preteen children is important. Likewise, it’s important to ask your patients in their teens and 20s whether or not they’ve been vaccinated. Even if a patient missed the recommended vaccine as a child and is sexually active, if she’s under the age of 27, it may still be beneficial because there may not have been exposure to all of the virus strains the vaccine protects against. If a patient refuses vaccination at first, it never hurts to keep offering it at future visits.

Like many things we discuss with our patients, there is still a lot of misunderstanding about HPV and cervical cancer.  That’s why it’s so important to continue to encourage annual well woman visits and HPV vaccinations. For more information to help guide your conversations with patients, visit ACOG’s Immunization for Women website, shotbyshot.org, or the National Cervical Cancer Coalitions Cervical Cancer Awareness Month page.

We Cannot Afford to Have the Clock Turned Back on Women’s Health

As we begin a new year, a lot is at stake for Americans’ health. Our nation’s leaders have promised substantial changes to the Affordable Care Act, from partial to full repeal, without the certainty of a replacement plan. While it can be easy to get caught up in the politics of health care, as ob-gyns our focus has always been on our patients and ensuring that they have access to safe, high-quality health care. That is why a critical part of our work here at ACOG is to advocate for the health of women, and as millions of people face the possibility of losing health insurance coverage in the coming months or years, ACOG’s work has never been more important.

Earlier this month, ACOG partnered with three leading medical organizations—the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians—to urge Congress to avoid repealing the ACA without an immediate replacement which would protect and retain the landmark women’s health provisions in the law.

The ACA is not perfect. In fact, ACOG didn’t endorse it originally because we felt it didn’t meet the needs of our physician members. However, while there’s lots to improve, the ACA does include really important protections for our patients’ health. Insurers must now cover maternity and preventive care and contraceptives. It stops insurers from charging women more than men for the same coverage, prevents insurers from denying coverage to women who were victims of domestic violence or who had a Cesarean delivery in the past. The ACA also guarantees women direct access to their ob-gyns without any limitations.

The coverage provided under the ACA allowed many women to schedule routine doctor’s appointments for the first time in their lives. We all know that when people have insurance, they’re more likely to use preventive care like mammogram and diabetes screenings that prevent more costly and life threatening health problems down the line.

Whatever one’s reservations may be about the law, as physicians we know how devastating it would be for a cancer patient to suddenly lose her coverage or for a pregnant woman to go without prenatal care and deliver a baby preterm because she could no longer afford health coverage. The fact is, low-income women are more likely to suffer from often preventable pregnancy complications and, unfortunately, that is the very population that stands to lose the most unless Congress protects these important benefits, including Medicaid expansion.

Today, 31 states and D.C. have expanded their Medicaid programs, offering coverage to 11 million newly eligible individuals. The most important part of the expansion to women is that those Medicaid programs cover low-income women even if they’re not pregnant. Regular Medicaid programs routinely only cover pregnant women through delivery and a few weeks after.

But speaking more broadly, all women stand to lose essential preventive care if the ACA is repealed. Access to breast cancer screenings decreases women’s likelihood of dying from the disease by up to 50 percent. Routine cervical screenings decrease the odds of late-stage cancer diagnosis by 60 percent. Finally, when women have access to more choices of affordable and effective contraception, including IUDs and implants, rates of unintended pregnancy, unplanned birth, and abortion drop dramatically.

In 2016 alone, 6.8 million girls and women gained health insurance coverage. If the law is repealed, those gains will likely be lost. We cannot turn back the clock on women’s health. The care we provide doesn’t stop in our exam or delivery rooms. It’s our responsibility to advocate on our patients’ behalf and protect their access to affordable, comprehensive health care. So let’s mobilize and use our collective community’s influence and expertise to ensure access to health care in this country.

To become involved in ACOG’s advocacy efforts, join us at the 35th Congressional Leadership Conference, The President’s Conference in Washington, D.C., in March.

Prevention of Preterm Birth Starts with a Healthy Mom

November 17 is World Prematurity Day. It gives us, as health professionals, an opportunity to direct our attention to a devastating health issue that impacts 15 million babies each year and rededicate ourselves to reducing that number. Several organizations, including ACOG, are supporting the cause through education, awareness, and advocacy events. However, there’s one event in particular that, coincidentally, started this week and stands to make the most significant impact in terms of lowering the preterm birth rate in this country and that’s open enrollment through the Health Insurance Marketplace.

Prevention of preterm birth starts with a healthy mom and that means access to prenatal care and preventive services. There are several risk factors for preterm birth, some of which include high blood pressure, low pre-pregnancy weight, alcohol and drug abuse, smoking, a prior preterm birth and a birth less than 12 months ago. Adequate health insurance coverage can make the difference between a pregnant woman carrying to term or delivering too early and the Affordable Care Act has helped make that coverage accessible to millions of women.

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