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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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Women’s Health

TBI experience, recovery different in women, men

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December 03, 2021

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Biography / Disclosures

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Biography:
Odette Harris MD, MPH, is Professor of Neurosurgery and Director of Brain Injury at Stanford University School of Medicine. She is also the deputy chief of staff for rehabilitation in the Palo Alto Health Care System of the Veterans Administration and site director of the Center of Excellence for Traumatic Brain Injury.

Disclosure: Harris does not report any relevant financial information.

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Most studies of traumatic brain injuries, particularly those relating to military populations and blast injuries, included primarily or exclusively men.

It’s not uncommon to find papers on traumatic brain injury (TBI) in which only 5% or 1% of the study cohort were female without attempting to analyze whether it was in this small percentage of women compared to the group There were differences as a whole.

Without further information, we may draw erroneous conclusions about the experience and recovery of women with TBI. Our treatment strategies, whether rehabilitative care or neurosurgical emergency procedures, are therefore significantly less evidence-based in female patients than in male patients.

Odette Harris

A few years ago, my colleagues and I carried out a literature search to find out what is known so far about gender differences in TBI (Kim et al.). We found that depression was more common in women than in men. In addition, women were dramatically more likely than men to report somatosensory deficits, including vestibular, oculomotor, and proprioceptive problems related to vision.

A lot more work is needed to understand the nuances behind these results. In particular, we need larger retrospective data sets that include more women, as well as prospective data collection by gender that assesses both brain structure and function.

My neuroscientific colleague Maheen Adamson, PhD, was looking for surrogate markers in the brain that could help us understand the relationship between brain structure and functional changes after TBI. Cortical thickness is one such potential marker, widely used in imaging studies of neurological disease progression, but we don’t yet know how reliable it is in tracking acquired brain injuries like a TBI.

In healthy brains there are gender-specific differences in this marker: women have a cerebral cortex that is about 6% thicker than men. Both men and women experience cortical thinning after a TBI, but imaging studies suggest that female veterans had greater cortical thinning than their male counterparts.

Ideally, we want to see how these physiological changes in the brain correlate with patients’ symptoms and functional outcomes. We are still at the very early stages of this work, but it holds the promise of better understanding and predicting response to treatment.

This work could be transferred to other subpopulations in addition to women – for example to older or younger patients or to certain types of injuries. It’s not that the literature on TBI is untrue, it’s just that it isn’t nuanced enough to ensure the most accurate treatment.

I am pleased that many different disciplines are noticing and addressing this issue. With ongoing efforts, I am optimistic that we can develop a more complete picture of how the brain and brain function of women are affected by TBI so that we can practice truly evidence-based neurosurgery and rehabilitation after brain injury.

Reference:

For more informations:

Odette Harris MD, MPH, is Professor of Neurosurgery and Director of Brain Injury at Stanford University School of Medicine. She is also the deputy chief of staff for rehabilitation in the Palo Alto Health Care System of the Veterans Administration and site director of the Center of Excellence for Traumatic Brain Injury. Harris focuses on collaborative approaches to implementing and optimizing algorithms that aim to improve outcomes in neurosurgical care. She is a National Medical Fellowship for Excellence in Academic Medicine and has received many other awards for her clinical and research work. She is the past president of Women in Neurosurgery and the director of the California Association of Neurological Surgeons.

Disclaimer: The views and opinions expressed on this blog are those of the authors and do not necessarily reflect the official policies or position of the Neuro-Optometric Rehabilitation Association, unless otherwise stated. This blog is for informational purposes only and is not a substitute for professional medical advice from a doctor. NORA does not recommend or endorse any specific tests, doctors, products or procedures. You can find more information about our website and online content here.

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Women’s Health

Opinion | Abortion: The Voice of the Ambivalent Majority

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If you want to know why our policies are so dire, check out our public debates on abortion over the past 72 hours.

Everyone suspects where the Supreme Court is going with regard to Roe v. Wade seems to be steering. But as our policies have become rougher and more combative, many conservatives do not even recognize the problems that have always made this subject so difficult. For example, how do we show appropriate respect and respect for women who become pregnant in dire circumstances? How do we respect women who say, “This is not abstract. This is my body and my private concern? ”What would it look like to ban abortions where the vast majority do not believe that life begins with conception? Many conservatives focus on the fetus to the exclusion of everything else.

On the other hand, many of the progressive comments will not recognize the fetus at all. In the past day or two, I’ve seen progressive abortions referring to just female health care or a completely private choice of what a woman does to her body. Many progressives speak of abortion as if it could not possibly mean the end of a human life.

Right now, in the post-Trump degradation of public life, politicians, propagandists, and activists on this issue are leaving out the tough and complex issues in order to vigorously represent their side. And that’s what we see in issue after issue. The armies of certainty march forward and dominate debate and politics. The rest of us are left behind, hampered by ambivalence. We live in a democracy in which the majority often does not rule.

To a professional expert, I have written remarkably little about abortion because I am so torn. For most of my life, I’ve believed myself to be an election supporter because I didn’t trust that I knew when life began and I didn’t want to impose my views on others. But as with many people, my life has crossed with the topic.

When I was around 19, a friend came home from college and found she was pregnant. She asked me to guide her through the abortion process, which I did. My progressive milieu did not prepare me for the moral and emotional torment she went through before and especially after the abortion. I realized how serious this issue was and the humility with which it had to be approached.

Then came science. Like many people, I have been influenced by the sonograms and how they show a human form in the early stages of the fetus.

I have read many books about human development and what I realize is that things happen in the womb much earlier than we used to think. After 20 or 21 weeks, before what was considered viable, the fetus starts sucking its thumb, moving its eyes, and hearing noises. A female fetus has eggs of its own. These are sobering realities.

Then miscarriages occur. I’ve seen many grieve over miscarriages. I mourned myself. It doesn’t feel like the loss of some cells, but of life.

The experience and the resulting moral sentiments have moved me many levels towards an anti-abortion position. Does that mean I know when life starts That doesn’t seem like the right question anymore. I have come to believe that all people have a piece of themselves that is neither size, shape, color nor weight, but gives them infinite value and dignity, and it is their soul. For me the crucial question is when a living organism becomes a human soul. My intuition is that it is not a moment, but a process – a process shrouded in divine secrets.

Unfortunately, that leaves me in a monotonous political position – with about half of Americans who want to restrict abortion under certain circumstances, but – perhaps because they think it’s impractical or wrong – don’t want to ban it altogether. Third trimester abortions and some second trimester abortions seem increasingly wrong to me, except in exceptional circumstances. But the first trimester? I don’t know, and that’s why I would bow to any woman’s conscience.

Given where the Supreme Court seems to be going, I would endorse the compromise position that Claremont McKenna Professor Jon A. Shields outlined on these pages in October, which could include tightening abortion restrictions after the first trimester.

I think that means I stand up for John Roberts in the current deliberations on the Dobbs v Jackson women’s health organization. He has signaled that he is open to consider whether the court could uphold Mississippi law banning abortion after 15 weeks but not repeal Roe and allow states to enact total or near-total bans. But he can be in a minority.

I used to support the overthrow of Roe because I thought it would be healthy to take the abortion issue out of the courts and back to the state legislatures. I used to think that most states would end up where the nation’s center of gravity was – with restrictions, but not prohibitions.

But we are now trying to tackle a pathetically complex issue in a brutalized political culture. Majorities do not rule in this country; polarized minorities do. The proof of this week is that post-roe politics would make even our current politics seem tame. I’m not sure our democracy is strong enough for that.

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Women’s Health

Embryo donation: One possible path after IVF

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In vitro fertilization (IVF) has made it possible for countless people to have children for decades, often after years of disappointment. It’s a complex process, medically and emotionally. Those who begin an IVF cycle are often focused on the baby they crave. Most hope that one cycle will produce multiple embryos, as more than one embryo transfer is often required to achieve a successful full pregnancy.

Any remaining embryos can offer hope for future pregnancies and more children. But remaining embryos also bring difficult decisions to the fore – if not immediately, then in the following years. The choices a person or couple makes can be broken down into five avenues. One way – donating embryos to another person or couple in the hope of having children – raises many questions. This path and these questions are the subject of this post.

A decision-making path for people who have become parents through IVF

If you became parents through IVF and still have embryos, you are not alone. Estimates of the number of cryopreserved embryos in the United States vary, but it is likely to be in the hundreds of thousands.

You can be among the many people or couples who intend to use their embryos, or those whose family feels complete. And you may start figuring out what to do with your embryos, or you may put the decision on hold, pay for annual embryo storage and feel no urgency to make a decision as embryos can be safely frozen for many years. Having “extras” in the freezer can offer comfort, some sort of psychological insurance after years of disappointment and loss.

However, sooner or later most people will find themselves at a decision point when considering these options:

  • You can dispose of your remaining embryos. This can feel more difficult than you expected, but absolutely doable. You see these embryos as part of the IVF process that made it possible for you to have your beloved child or children. The word “dispose of” sounds harsh, but you are unwilling to raise another child and do not see them as an option to donate them to someone else.
  • You can choose to have another child. Having a larger family wasn’t what you planned or hoped for, but you are seeing additional embryos as part of IVF and a new child than intended. You look at your family and decide it is worth undergoing at least one more embryo transfer before making a final decision about disposal.
  • You can choose to donate your embryos to science. Unfortunately, when you start exploring this you will find that there is no easy way to do it. You may choose to explore other possible avenues or focus on one of the other options.
  • You can donate your embryos to someone else or to a couple. For some it feels natural: they have been given children and want to pass them on to others who long for pregnancy and parenting. For many, however, the decision to donate is neither easy nor natural. Rather, it presents a huge dilemma: you want to honor the embryos and offer them a chance at life, but you have unsettled feelings when you think about your genetic offspring being raised by another family.
  • Not to be decided is to be decided. In listing the options, it is important to acknowledge that some of your IVF colleagues choose not to make up their minds. They are among the many who have “given up” their embryos (the term clinics use for families who avoid contact). You no longer pay storage fees; they do not respond to outreach calls and letters.

What questions arise when you decide to donate embryos to another family?

Author Anna Hecker wrote in TheNew York Times of her own decision about unused embryos: “For me, this far exceeds my discomfort. I see it as a life or death decision that makes it almost impossible to make. ”When couples make that decision, I can testify that this feeling of the” almost impossible “passes over time as people get along with it deal with their choice and arrive at a place of clarity and peace.

Below are some, if not all, of the questions you are likely to encounter while considering embryo donation. If you are part of a couple, these questions can be clarified with your partner. (If you’re single, the choice is yours.)

  • How would we feel if another family raised a child created with our genes?
  • Would it feel okay if we knew the family we are donating to, or could that make it harder to see how our child might have grown up with others as parents?
  • Is that fair to the children involved? How will our children feel when they know that they have full siblings in another family? What will you think of the fact that it was the random choice of an embryologist who determined which embryo ends up in our family and which in another?
  • How will children who come from our donation feel? Will they feel displaced as if they ended up in the wrong family? Maybe it will feel a bit like a science fiction project?
  • How will we perceive possible challenges in the future: Our child will get sick, the family to which we donate will be divorced, we vehemently reject the upbringing style and the values ​​of the other family?
  • If we choose to donate, how should we find a family? Does geography or demographics matter – for example, will it feel good or more complicated to have them around? Should we donate to a same-sex couple, elderly single woman, or others?
  • Do we want to tell family members and friends of our decision to donate our embryos? If so, how much of this information do we share?
  • If there are multiple embryos, do we all donate to the same family or do they share? For those who do not want to discard embryos, it may be important to make sure none are discarded when the receiving family is feeling complete.
  • If our embryos were created using donor eggs and / or sperm cells, should we get permission or consent from the donor? What do we do if we don’t have access to the donor?

These questions are complicated, best done over time and with care. While you may want to make the decision soon so that you can feel closed and move on as a family, I have found that this is one case in life where you move slowly, attend and rethink a decision, accept doubts, and take breaks have to. they all contribute to the fact that you ultimately feel that your decision is the right one.

As a service to our readers, Harvard Health Publishing offers access to our library of archived content. Please note the date of the last review or update for all articles. No content on this website, regardless of the date, should never be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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