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‘The higher the metabolic risk is, the higher the risk is to catch Covid-19’

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Here is what women need to know

May 23, 2021 3:06 PM

CNN

Posted: May 23, 2021 3:06 PM

Originally Published: 23 MAY 21 06:02 ET

Updated: 23 MAY 21 15:34 ET

By Alessandria Masi, CNN

(CNN) — Last July, when her immediate family tested positive for Covid-19, Breanna Aguilar did not fit into any groups considered at higher risk for severe disease.

She is 31 years old, a pet sitter and former fitness teacher who once ran a half marathon. She was, by most measures, healthy.

When Aguilar got Covid-19 she lost her sense of taste, had mild fevers and muscle weakness. She could barely keep anything down yet gained about 30 pounds. Later, she developed pelvic pain, cystic acne, breast tenderness, headaches, brain fog and extreme fatigue.

It has been months since then, but she says the low energy, chronic pain and brain fog — long-haul Covid-19 symptoms — remain and she can’t even go for a 15-minute walk without needing a break. She’s also now dealing with insulin resistance and taking several medications to keep that and her hormone levels under some control. Her doctor told her she’ll likely be dealing with this fallout of Covid-19 for the rest of her life.

More than a year into the pandemic, one study has found that some women are at higher risk for Covid-19 compared to others in their age and sex groups. These women, often young and otherwise healthy like Aguilar, have an underlying condition that isn’t mentioned on any Covid-19 comorbidity list: polycystic ovary syndrome, or PCOS.

PCOS, which affect about 1 in 10 women of “childbearing age,” is an imbalance of reproductive hormones that can lead to irregular menstrual cycles, high androgen levels and ovarian cysts. But it can also come with a host of other health problems, nearly all of which overlap Covid-19 comorbidities.

“PCOS is completely underestimated in its impact. It’s sort of seen as some reproductive issue that is not clinically relevant. But this is completely wrong … Patients need to be seen as a high-risk population,” said Dr. Wiebke Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham in the United Kingdom.

More than half of people with PCOS develop diabetes before their 40th birthdays, and up to 80% are overweight. They have higher risk of insulin resistance, heart disease and endometrial cancer, a cancer that begins in the uterus. Many have high blood pressure and low levels of vitamin D. These complications of PCOS have also been associated with a potentially higher risk for severe Covid-19.

Despite how common PCOS is, as well as the serious complications it can come with, health experts say the condition has long been overlooked, misunderstood and under-researched, leaving patients to advocate for themselves or even educate practitioners to get treatment. And with very little research looking at whether women with PCOS are at higher risk for more severe Covid-19 or long-term symptoms, some fear the same is happening with public health policy around the pandemic.

“My advice would be to include women with PCOS as … potentially a high-risk group,” said Dr. Katherine Sherif, chief of Women’s Health at Jefferson University’s Department of Medicine and a leading PCOS expert. But she warned: “We’re working in a very large system that is full of silos. Nobody’s going to jump up and say, ‘Oh, well, don’t forget about PCOS.’”

“If Anthony Fauci said, ‘you need to look at the high-risk groups like PCOS,’ people might pay more attention,” she said.

Part of the reason PCOS flies under the radar in general and with regards to Covid-19, according to Arlt and Sherif, is because it is often dismissed as a women’s health issue — an obstacle of the ovary. Over the past year, we’ve learned about numerous preexisting health conditions that put a person at higher risk for severe Covid-19 illness, but PCOS isn’t one of them.

For Arlt, who co-authored the first major study published in February in the European Journal of Endocrinology, the name PCOS is a misnomer. It is not a disorder of the ovary, Arlt said, but a “lifelong metabolic disease” and should be treated as such when assessing Covid-19 vulnerability.

“The higher the metabolic risk is, the higher the risk is to catch Covid-19,” Arlt said. “People looked at obesity and Type 2 diabetes and hypertension and heart disease, but they have not looked at PCOS systematically before we did. Because they just don’t consider this a metabolic risk factor. That’s something that we would like to change.”

‘Something in PCOS is actually driving this’

Arlt and researchers at the University of Birmingham in the United Kingdom found that women with PCOS had a 51 percent higher chance of confirmed or suspected Covid-19 infection than women without. Using primary care records from January to June 2020, they identified more than 21,000 PCOS patients and a control group of more than 78,000 without, matched for age and location.

Researchers then “wanted to understand if the increased incidence of Covid-19 was only because of PCOS, or was it also because of the underlying risk factors that women with PCOS have?” lead author Anuradhaa Subramanian told CNN. In other words, if a woman has PCOS and Type 2 Diabetes, which one is putting her at increased risk for Covid-19?

In a fully adjusted model that took various risk factors into account, women with PCOS still had a 28% increased risk for confirmed or suspected Covid-19 infection, according to the study.

Subramanian says the results didn’t surprise her. However, “it gave us more confidence… that it’s not just about the risk factors associated with PCOS, but something in PCOS is actually driving this,” she said.

But because the data was pulled from primary healthcare databases, researchers couldn’t look at whether patients with PCOS had more severe or long-term Covid-19 symptoms. What’s more, PCOS is not a one-size-fits-all disorder and Covid-19 may or may not have a different impact or risk level depending on the person. There are many questions we don’t have definitive answers to yet, says Dr. Anuja Dokras, director of the Polycystic Ovary Syndrome Center at Penn Medicine.

“We need to get this information now that (Covid-19 has) lasted a full year,” said Dokras. “It’s affecting so many people that it would be good to look back at this literature and just sort it out because these are confounding factors.”

Searching for answers

So far, whether people with PCOS have more severe complications from Covid-19 is anecdotal, leaving some women with only speculation about how Covid-19 affects PCOS.

In Aguilar’s case, she was diagnosed with PCOS after she was exposed to Covid-19, despite likely having it for years but not recognizing the symptoms. “I had some of these underlying symptoms, my body was able to just manage them to a point for most of my life, and then contracting Covid really just wiped out all of my body’s defenses and ability to regulate anything,” she said her doctor told her.

But she still doesn’t know why or whether her symptoms will ever improve.

Kris Nealon has also spent much of the past year looking for answers.

She was diagnosed with PCOS at age 12, and the disorder has left her struggling with her weight and insulin resistance. These factors, she says, made her concerned that she could have severe Covid-19 symptoms and maybe even require hospitalization. So last summer she did what most have done during the pandemic: She Googled it. She recalled searching “‘should I be concerned…insulin resistance COVID?’ or ‘PCOS COVID?’”

Nealon didn’t find answers. She got Covid-19 in October and says her symptoms were mild. But when that turned into muscle and joint pain, extreme fatigue, depression, insomnia and brain fog, she did what was recommended: Talk to her doctor.

In Nealon’s case, she spoke to several. Having lived with PCOS more than half her life, she was aware of the complications and wanted to know how this could impact her long-term Covid-19 symptoms.

She says the primary doctor for her long-term symptoms said her only Covid-19 comorbidity was her weight.

“He’s been nice and understanding but … you can see him be like, ‘Lady problems, don’t worry about it. This is your lungs,’” she said. She told him that PCOS is linked to anxiety and depression and asked if that could be related to Covid-19 fatigue and insomnia. She also asked about her heart, explaining that PCOS and Covid-19 can cause complications.

But aside from suggesting that losing weight might help, Nealon recalled her doctor saying “it had nothing to do with PCOS. He’s like, ‘no, that’s your ovaries and stuff.’”

After Covid-19, Nealon also noticed her PCOS symptoms “went crazy.” She says she had extreme pain in her lower abdomen. An ultrasound showed her fallopian tubes “suddenly looked very concerning” and she had an ovarian cyst burst.

She went to her gynecologist, the doctor who first diagnosed her with PCOS, and asked, “Does this have anything to do with (that) I just had Covid?”

She says her doctor told her: “No, there’s no literature about that.”

And there wasn’t. Weeks after Nealon tested positive, Allison Roach and Chitra Gotluru, two medical students at Florida International University, finished their journal article exploring the potentially higher risk women with PCOS have for Covid-19-related morbidity. No data set of patients with both diagnoses existed, they said.

Risk ‘obvious but not proven’

Roach’s and Gotluru’s research, published in the March issue of the journal Obstetrics and Gynecology, shows the potentially higher risk for PCOS patients comes down to “comorbidities, androgens and lipotoxicity.”

People with PCOS often have higher levels of and sensitivity to androgens, male sex hormones. This could “potentially directly affect the susceptibility to COVID-19,” Roach and Gotluru wrote. Androgens work as a “gateway,” in very simple terms, to let in Covid-19, Roach says.

What’s more, it is common for people with PCOS to have chronic inflammation — an immune system that is in a near-constant state of fighting off harm. Impaired insulin regulation and obesity can lead to a toxic buildup of fatty acid in tissue, known as lipotoxicity, potentially damaging organs.

This can also trigger the secretion of immune-signaling cells called cytokines. While cytokines are a vital part of the body’s immune response, too much can cause what’s known as a cytokine storm. Adding a Covid-19 infection to that can cause further cytokine secretion, potentially triggering one of these storms and causing the immune system to attack the body’s cells, not just the pathogen. And there is research that suggests this can occur “whether you are overweight or not,” Gotluru told CNN.

For Jefferson University’s Sherif, the risk of more severe Covid-19 symptoms for PCOS patients is “obvious but not proven.” Obvious because “If testosterone increases inflammation, and if … men who are in the hospital with Covid complications and have high testosterone levels, it makes sense that it would put women with PCOS more at risk.”

This is not proven, she says, because so little research exists.

Drawing from her own research about PCOS and heart disease, Sherif said, “What’s important for people to understand is that this is independent of obesity.”

“It’s the high insulin and high testosterone that confer their risk for a greater risk for Covid compared to weight matched controls,” she said. “So, you have two women who are 100 kilograms. The one with PCOS is more likely to become diabetic or have sleep apnea, or to be sick from Covid.”

Without that data, some doctors and researchers say this is something patients with PCOS should be aware of, but not to panic. If you do get Covid-19, it’s important to tell your doctor you have PCOS and any medications you’re taking, Gotluru says.

“Let your provider know … that there is research out there that is worrisome about PCOS and you’d like to be careful,” she said.

In the meantime, women like Aguilar and Nealon are still searching for answers. Nealon says her doctors still haven’t made a connection between the fallout of Covid-19 and her PCOS. She isn’t surprised.

“That’s what it’s like, just with PCOS, let alone adding Covid in,” Nealon said. “You go to a doctor with a list of symptoms, and you either get ‘you’re fat’ or ‘you’re overthinking things.’”

Aguilar says that constantly having to educate people in her life has been exhausting on top of her two new diagnoses.

“A lot of people like to talk about the survival rate is so high and the death rate is so low, but what they’re not taking into account is the degree that lives are changing because of illnesses that are popping up from this, or just the long-haul symptoms that are so debilitating,” Aguilar said. “It’s hard to overcome.”

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Women’s Health

Lack Of Female Inventors Hinders Women’s Health Innovation

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New research published in Science points to a gender imbalance in R&D that has implications for women’s health. It is an important step in showing how inequality in the labor market can lead to inequality in the product market.

Why are women’s diseases, anatomy, or needs generally overlooked by inventors? New research points to a gender imbalance in R&D affecting those who benefit from invention.

Professors Sampsa Samila of IESE Business School, Rembrand Koning of Harvard Business School, and John-Paul Ferguson of McGill University analyze more than 430,000 U.S. biomedical patents filed between 1976 and 2010 and point to missed opportunities who reveals this pattern. Your paper “Who are we inventing for? Women’s patents are more focused on women’s health, but few women can invent anything, ”is published in the journal Science.

Today only about 13% of US patent inventors are women. But this study showed significant progress over the years: in 1976 only 6.3% of biomedical patents were from women’s teams, compared to 16.2% in 2010. There is evidence that this 10 percentage point increase has resulted in significantly more innovation affecting women’s health.

There is also evidence that women, who currently make up about 35% of STEM researchers, are no more likely to be in the ranks of patented inventors for several reasons – including gender bias in the labor market and in making decisions about which R&D opportunities are valuable are deemed to be prosecuted by managers.

“The results effectively show that inequality in the labor market could lead to inequality in the product market,” explains IESE Business School Prof. Samila. “In other words, discrimination in the labor market affects not only those affected, but affects society as a whole, as the contributions of the disadvantaged are absent.”

The good news is that breaking down barriers for disadvantaged groups should help fuel innovation and economic growth. “Perhaps there are still many unused market opportunities for women that could in turn improve women’s health,” the co-authors state.

Innovation inequality
There is anecdotal evidence of progress made by women inventors. For example, entrepreneur Surbhi Sarna pulled out of her own fear of ovarian cancer to invent a better cancer detection tool. Another, Dr. Patricia Bath, invented a more precise treatment for cataracts, which affect women more often than men. This new research backs this with a systematic analysis of data that finds that all-female inventor teams are 35% more likely to focus on women’s health than all-male teams. Interestingly, male inventors focus their patented innovations less often on male or female health issues than their female counterparts.

While inventor teams with some women also follow a sex-focus pattern, the pattern is “strongest for purely female invention teams, lasts for decades and is even present in narrow areas of invention”, as the co-authors summarize. This last point “indicates that the link between inventors and inventions is both the result of women working in more women-centered research areas”. [e.g., gynecology] and female inventors identify opportunities for women to invent, regardless of their field of activity [e.g., ocular surgery procedures]. “

Prof. Samila thanks for funding this project from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 799330.

Click here to view Forbes India’s comprehensive coverage of the Covid-19 situation and its impact on life, business and the economy

[This article has been reproduced with permission from IESE Business School. www.iese.edu/ Views expressed are personal.]

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Women’s Health

Britney Spears has every right to be angry — at all of us

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On Wednesday Britney Spears told a judge she was “traumatized” and “angry” because she cannot make important decisions about her life and called for the abolition of a judiciary conservatory.

Under the Conservatory, her father, Jamie Spears, has been in control of her private life since 2013 (except during a hiatus in 2019 due to his health problems). He also controlled their finances until February when an asset management company was named co-curator of such decisions.

Of all the disturbing things about this situation, one of the most troublesome is that we even know about it.

On Tuesday, the New York Times released details from confidential court records showing that Britney Spears has long opposed the agreement. She said she was subsequently admitted to a mental health facility against her will, forced to perform with whoever she was allowed to date with a 104-degree fever, and was even prevented from changing the color of her kitchen cabinets. At the hearing, she also said she was given the drug lithium and forced to remain on birth control, touring and performing against her will. This lack of autonomy is appalling.

One of her father’s attorneys told People earlier this year, “Britney knows that her daddy loves her and that he’s there for her when and when she needs him, just as he has always been – conservatory or not.

There are so many annoying elements here that it is difficult to decide where to start unpacking them all. But, first, in the case of adults, conservatories are established when a person is not considered competent to make decisions that serve their own interests. This suggests that Spears continues to suffer from serious problems. Of course, it’s hard to imagine that she has no problems considering how she’s been sexualized by the media and followed by paparazzi.

But there is also reason to believe that the conservatories were overly controlling. After all, Spears released four albums during the time of this arrangement, including two that sold platinum; served as a judge on two television shows; and reportedly earned $ 138 million performing in Las Vegas. NPR notes that “these accomplishments do not exactly match the typical profile of someone unable to take care of themselves.”

And in November, Spears’ attorney said she stopped working and will not go back to work while her father controls her career. That alone suggests that the conservatory is not working for them.

But there is something more disturbing: the fact that we even know about it. The Conservatory itself, and whether it remains the right course of action or ever was, is about Spears’ mental health and finances. These are issues that you – and every woman (and man) – should have the right to keep private. In the United States, the right to privacy regarding these concerns is so clear that the Freedom of Information Act specifically excludes private medical records and financial information from government disclosure.

Reporting by the Times and other news outlets is not illegal, but it is difficult to understand the public interest served by digging up suggestive details about a woman’s personal life.

While Spears has asked for her testimony to be made public, after all she has endured, it’s understandable that she would want a chance to tell her side of the story. As she said on Wednesday, “By keeping this on for so long, it’s not good for my heart. It worries me that I can’t be heard. I have the right to use my voice.”

The world just has no right to know all of these things about Spears. But of course the public and the media love to obsess and judge the most intimate details of women’s lives in public. As Jill Filipovic (a CNN Opinion contributor) noted in her book “The H-Spot: The Feminist Pursuit of Happiness”, men simply do not face the same “jeweler’s loupe control” in “every life decision they make”.

Since Spears is an artist, we should judge her by her art. The fact that every fan, reporter, and media commentator believes it is their right to be informed about and meddle in Spears’ most personal affairs is a disturbing type of interference that doesn’t change much from the nature of the Conservatory itself is different.

For that reason, even the documentary released earlier this year by the New York Times – which portrays the #FreeBritney activists’ opposition to the conservatories and suggests that the media and music industry are responsible for many of the star’s problems – so disturbing. “I didn’t see the documentary, but I was embarrassed about what I saw, the light they put me in … I cried for two weeks,” Spears wrote on Instagram.

Put yourself in Spears’ shoes. The fact that she has struggled with a setup that has such great control over so many aspects of her life is horrible enough. Nor should she have to think about how her pleading before a judge before the court of public opinion will turn out to be. These matters should be treated confidentially.

What happens to Spears also sends a troubling message to other women: that we cannot rely on privacy when dealing with the legal system. No wonder, then, that other women often fail to turn to the courts when faced with their own daunting problems, from rape to revenge porn.

No one has the right to intrude into the personal health and financial details of women’s lives, even when they are in the public spotlight. These days, it’s not just a judge who should look carefully at what Spears is facing. Fans and reporters also need to think carefully about how they treat women in public so that in the future they won’t find out, like Spears singing, that they did it all over again.

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Contraception, Planned Parenthood dominate debate as Missouri Senate returns to Capitol • Missouri Independent

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Senator Bob Onder, a Republican from Lake St. Louis (photo courtesy Missouri Senate Communications).

If state lawmakers approve Governor Mike Parson’s proposed restrictions on Planned Parenthood’s participation in state medical funding, it would cost the organization no money.

Legislators are back in session this week because they failed to raise supplier taxes earlier this year important to Medicaid funding following a push by Conservatives in the Missouri Senate who decided to prevent Planned Parenthood from receiving taxpayers’ money through the Medicaid program

As a concession to these senators, Parson’s request for a special session to renew taxes included a provision that would discourage Planned Parenthood from becoming a vendor for the uninsured women’s health program. This $ 11.5 million program provides family planning services to low-income women who would otherwise not qualify for Medicaid.

But Planned Parenthood of the St. Louis Region and Southwest Missouri and Planned Parenthood Great Plains “are not receiving government-funded reimbursements under the uninsured women’s health program,” Angie Postal, vice president of education, public policy and community involvement for Planned Parenthood of the St Louis during a conference call with reporters on Wednesday morning.

The special session started shortly after noon on Wednesday. The goal of the legislature is to have a bill passed and ready for signature by Parson by next Wednesday, the last day of the state financial year.

The focus of the measures will initially be on the State Senate, where a bill to extend supplier taxes will be presented died early in the morning the last day of this year’s regular meeting. Senate leaders plan to debate and vote on the bill on Friday and Saturday, with House measures expected to follow early next week.

During the regular session, the abortion policy failed to expand taxes when lawmakers tried for the first time in 30 years to use them as a vehicle to pass borders some contraceptive medications and devices and to rule out planned parenthood Providing services to every Medicaid customer.

Service provider taxes, known as federal reimbursement lump sums, have been used since 1992 to fund a significant portion of the Medicaid program in Missouri. According to the figures quoted by Parson on Monday, taxes on hospitals, nursing homes and other providers are to provide US $ 591 million as direct support and to provide the state with US $ 1.5 billion in federal matching funds in the coming fiscal year.

Without renewal, taxes will expire on September 30th.

The impasse became more and more frustrating for Parson at the beginning of the financial year. On several occasions in the past few weeks, an agreement among the Republicans seemed near.

On Monday, Parson presented the General Assembly with an ultimatum, called for an agreement that would allow swift adoption by July 1st. Without them, he would cut $ 722 million from the state budget for the coming year.

“For those who want to move the goalposts again,” said Parson on Monday, “you know that you and you alone have this.”

However, the opening of the session could not suppress the republican power struggles.

sen. Bob under, talk about KCUR on Wednesday morningParson said he was trying to thwart its efforts to prevent Planned Parenthood from providing Medicaid services, noting that the governor’s public statements were praised by Senate minority leader John Rizzo, D-Independence.

“The governor is doing exactly what an abortion advocate like Senator Rizzo wants to do, which is to put the money into Planned Parenthood,” said Onder, R-Lake St. Louis.

Rather than restricting the provisions aimed at planned parenting to the health program for uninsured women, the ban should be as broad as possible, Onder said in an interview with The Independent.

“We should defuse Planned Parenthood throughout the Medicaid program,” said Onder, “not just in the health program for uninsured women.”

What it means

Healthcare providers and reproductive rights advocates say that attempts by Republicans to define common forms of birth control as drugs that promote abortion are contrary to medically recognized science.

The proposed bills would exclude contraceptives such as intrauterine devices, better known as IUDs, and several contraceptives from reimbursement under the state Medicaid program “if they are used to induce an abortion”.

One of the drugs is levonorgestrel, which is also used in many long-term contraceptives.

The association of drugs and IUDs with abortions is medically inaccurate and misleading, said Colleen McNicholas, chief medical officer for Planned Parenthood for the St. Louis and Southwest Missouri area.

The full list of prohibited drugs includes mifepristone and misoprostol, levonorgestrel, ulipristal acetate – sold under the brand name Ella – “and other progesterone antagonists”.

Mifepristone and misoprostol, alone and together, are widely used to induce abortion in early pregnancy.

IUDs and emergency contraceptives work to prevent pregnancy – not terminate it, medical experts said in interviews with The Independent and in an online press conference Wednesday.

Even Onder, a doctor, found that IUDs prevent pregnancy, not terminate it. During his appearance on KCUR, he said that Parson’s call read “after the word IUD” for “abortion”.

“Honestly, IUDs are not used for abortions … This language, which is still discussed and written as we speak, is not going to ban IUDs for birth control or really anything else,” Onder told KCUR, and later added, “After At the current state of the language there is probably no reason to even include it.

Emergency contraceptives such as Plan B or Ella are usually taken as soon as possible, but no more than five days after sexual intercourse. They work to delay ovulation, the release of an egg from an ovary. If a person’s body has already started this process, the contraceptives would not be successful in preventing pregnancy, McNicholas said.

In addition to preventing ovulation, other forms of contraception, such as IUDs or hormonal birth control pills, can help change the environment around the uterus, making it more difficult for sperm to reach and fertilize an egg.

Missouri law defines life as from the moment of conceptionwhich the law outlines as “the fertilization of a woman’s egg by a man’s sperm”. But pregnancy occurs when a fertilized egg is implanted in the lining of the uterus, McNicholas said.

“What matters is that there are certainly ideological thoughts about when to begin pregnancy, but timing of pregnancy is out of the question in the medical community,” McNicholas said.

Combining birth control with abortion-inducing drugs is thought to create confusion and uncertainty, said Michelle Trupiano, executive director of the Missouri Family Health Council, Inc.

“The concern about language is that it is left to non-healthcare professional interpretation and could have a deterrent effect on healthcare professionals and the use of IUDs as it creates uncertainty that people are not really sure what it is is. “and is not allowed,“ said Trupiano.

Elizabeth Allemann, the medical director of the Missouri Family Health Council Inc. and a family doctor with her own practice in Columbia, said she was particularly concerned about legislators’ access to emergency contraception, which the sooner it is taken and, in some cases, the more effective it is States offered to victims of sexual assault.

“Lifting barriers for emergency contraception means taking them off the table,” said Allemann.

Ultimately, restricting access to birth control would likely lead to more unwanted pregnancies, in addition to higher costs for the state, families and the birth of babies, Allemann said.

“And what we do know is that unwanted pregnancies are much more dangerous,” said Allemann. “There is a much higher risk of complications, premature birth, stillbirth, and maternal complications, including maternal death.”

Senate meeting

The special session opened on Wednesday in the Missouri Senate with the submission of three bills – one that extends taxes for five years, one that includes contraceptive language and the prohibition of planned parenting as stated in Parson’s appeal, and one that all of this combined in a single bill.

That alone was enough to arouse suspicion among Republican lawmakers, who were the strongest proponents of introducing the restrictions.

“The last time we discussed it, I had the impression that we were going to make an invoice,” said Senator Paul Wieland, R-Imperial and sponsor of the original language on contraceptives.

The draft bills are heard in the Senate Approval Committee, which passed extension laws in its regular session without any language targeting contraception or planned parenting. If the Senate receives a bill that meets the terms of Parson’s appeal, Onder can see a scenario in which further changes are ruled out.

“It would be a grotesque abuse of Senate rules to throw something like that out of order,” said Onder.

The decision would be challenged, and he warned other senators that Missouri Right to Life would evaluate the vote.

Rizzo offered a bill that would extend taxes by five years. He said all other issues should be set aside.

“This has given us the best return on our investment when it comes to health grants in the state of Missouri,” said Rizzo.

The timing of trying to block birth control and attack planned parenting is suspect, said Senator Brian Williams, D-Ferguson.

The resignation of US Senator Roy Blunt has created opportunities in Republican areas. Several state senators are planning to run in the 4th Congressional District, which US MP Vicky Hartzler is giving up to run for Blunt’s seat.

“I think it’s about political ingratiation,” said Williams. “I think it’s the people who want to make headlines about politics.”

Republicans dismissed this claim, arguing that President Joe Biden’s administration is seeking to repeal the Hyde Amendment preventing Medicaid from paying for abortions and that the Missouri Supreme Court should use its language on spending bills aimed at planned parenting has deleted.

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