For several hours on Sunday afternoon, speakers shared their own accounts with near-death experiences or the death of a loved one due to pregnancy-related causes. Several people from AWHONN’s office attended. You may have seen some of the social media posts.

The stories are heart wrenching. I find myself wishing Congress would take action on Maternal Health Accountability Act and the Preventing Maternal Deaths Act so that we can make progress on reversing the rising maternal morality trend so no more stories of maternal deaths will have to be told on the National Mall. If you haven’t yet done so, please call your Senators and Representative and ask them to support S. 1112 and H.R. 1318. And, if they have already cosponsored these bills, a thank-you call is always appreciated. Your call can make a difference.

Sincerely,
Seth A. Chase

Updates for Monday, May 14, 2018

Budget and Appropriations
President Donald Trump’s Office of Management and Budget has sent to Congress a request to rescind $15.4 billion in appropriated funds. The request must be approved by Congress, which has 45 days to do so. Authorization for federal agencies to spend the money is on hold until either the 45 days run out or Congress takes a vote on the request. The largest single area the president asks to rescind is $7.0 billion from the Children’s Health Insurance Program–with $5.1 billion from unspent Fiscal Year 2017 funds that can no longer be spent and the remainder from a contingency account which likely will not be used.

Fiscal Year 2019 Appropriations
The Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Subcommittee unanimously approved its Fiscal Year 2019 appropriations bill last Wednesday. The bill would appropriate $6 billion for the Women, Infants and Children nutrition program.

Senate Labor, Health and Human Services, Education and Related Agencies Subcommittee Meeting
I joined other representatives of the associations in the Coalition for Health Funding last week in a meeting with the staff director for the majority (Republican) Senate Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee. From this meeting we learned that the subcommittee hasn’t yet received an allocation for Fiscal Year 2019 from the full Appropriations Committee. The subcommittee cannot begin crafting their bill until they receive the allocation.

The staff director expressed that she does not expect large increases for public health and health research programs–especially with a $500 million hole created by the expiration of 21st Century Cures money for opioids. The Senate will be begin marking up bills at the end of this month–starting with non-controversial bills such as Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies. The Labor, HHS, Education bill will likely be marked up toward the end of June.

Briefings and Hearings
The Senate Subcommittee on Labor, Health and Human Services, Education and Related Agencies held a hearing May 10 with Secretary Alex Azar on the Department’s the Fiscal Year 2019 budget request.

Coming Up:

• Today and tomorrow, Jacque will be attending the Task Force meeting on Research Specific to Pregnant and Lactating Women via webinar from the National Institutes of Health. Recommendations from this meeting are used to shape and inform policy.
• We are soliciting input from AWHONN’s Public Policy Committee and Research Advisory Panel in order to respond to comments due 5/21/18 on draft recommendations for Screening for Intimate Partner Violence, Elder Abuse and Abuse of Vulnerable Adults and Behavioral Counseling to Prevent Sexually Transmitted Infections.   Public comment can also be made at https://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment. You can also submit your comment to us at [email protected] to be included in AWHONN’s response.
• On Wednesday, I’ll be attending the Women’s Health Empowerment Summit.
• On Friday, I’ll be joining Friends of Title V Maternal and Child Health Services Block Grant Program in meeting with Laura Kavanagh, the acting associate administrator for Health Resources and Services Administration’s Maternal and Child Health Bureau.

Seth A. Chase is the director of government affairs at the Association of Women’s Health, Obstetric and Neonatal Nurses.

Sign up to get AWHONN Legislative Update delivered directly to your inbox every Monday when Congress is in session by sending an email to [email protected].

Tobacco
According to a story run by BuzzFeed News, the Food and Drug Administration is cracking down on the sale of JUUL brand e-cigarettes, which are very popular among teens and young adults. The FDA has sent warning letters to 40 retailers after federal inspectors found that they sold JUUL e-cigarettes to minors, and asked JUUL for data on its marketing of the product and any potential side effects. AWHONN supports comprehensive tobacco control initiatives. In addition, nurses should screen women for tobacco use (including e-cigarettes), counsel them about the effects of tobacco use and tobacco exposure, and have access to referral information that supports cessation efforts. In case you missed it, in September 2017 AWHONN published an updated position statement on Tobacco Use and Women’s Health which can be accessed here.

Maternal Mortality
Senate Health, Education, Labor and Pensions Committee ranking member Sen. Patty Murray (D-WA) said in a Committee hearing on April 24 that the Committee will consider S 1112, the Maternal Health Accountability Act during a hearing in May. The Committee has not yet announced a date for the hearing. AWHONN advocates for expanding research funding and opportunities to investigate and alleviate the causes of maternal morbidity and mortality and will attend the hearing if it’s scheduled.

Teen Pregnancy Prevention Program
According to a story in The Hill, the Department of Health and Human Services has announced an abstinence-focused overhaul of the Teen Pregnancy Prevention Program. The funding announcement reads that “projects will clearly communicate that teen sex is a risk behavior for both the physical consequences of pregnancy and sexual transmitted infections; as well as sociological, economic and other related risks…Both risk avoidance and risk reduction approaches can and should include skills associated with helping youth delay sex as well as skills to help those youth already engaged in sexual risk to return toward risk-free choices in the future.”

In total, tier one will award up to $61 million in funds, ranging from $200,000 to $500,000 per year. The second tier solicits applications to develop and test “new and innovative strategies” to prevent teen pregnancy while improving adolescent health and addressing “youth sexual risk holistically by focusing on protective factors.”

Health Insurance
A new Kaiser Family Foundation analysis of short-term, limited duration health plans for sale through two major national online brokers finds big gaps in the benefits they offer. Through an executive order and proposed new regulations, the Trump Administration is seeking to encourage broader use of short-term, limited duration health plans as a cheaper alternative to individual market plans that comply with the Patient Protection and Affordable Care Act’s requirements. Repeal of the individual mandate penalty – which currently applies to people buying short-term plans – is also expected to boost enrollment starting next year.

Religious Refusal
According to a story in The New York Times, the Trump administration plans to implement the proposed rule, Protecting Statutory Conscience Rights in Health Care; Delegations of Authority, which seeks to permit discrimination by providers in all aspects of health care without adequately protecting patients from discrimination in accessing health care services. This new rule would roll back an Obama Administration rule that protects transgender people from discrimination by doctors, hospitals and health insurance companies. AWHONN submitted comments opposing the rule.

This proposed rule is not necessary to protect the rights of providers. It is the position of AWHONN that the existing rule issued in 2011 adequately protects the conscience of providers and patients. AWHONN asserts that nurses have the professional responsibility to provide nonjudgmental nursing care to all patients, either directly or through appropriate and timely referrals. AWHONN recognizes that some nurses may have religious or moral objections to participating in certain reproductive health care services, research, or associated activities. Therefore, AWHONN supports the existing protections afforded under federal law for a nurse who refuses to assist in performing any health care procedure to which the nurse has a moral or religious objection so long as the nurse has given appropriate notice to his or her employer. Additional information can be found in our position statement Rights and Responsibilities of Nurses Related to Reproductive Care.

Opioids Crisis

• The Senate Health, Education, Labor and Pensions Committee marked up S. 2680, the Opioid Crisis Response Act on April 16. The bill included measures to make it easier for opioids to be prescribed in smaller amounts, develop nonaddictive alternatives to opioids and strengthen border security to stop drug trafficking. It was passed by the subcommittee unanimously and will proceed to the full committee for a vote to go to the Senate floor. The bill also includes provisions to address treatment for pregnant and postpartum women in an effort to reduce instances of neonatal abstinence syndrome.
• On April 25, the House Energy & Commerce Health Subcommittee approved a package of 57 bills addressing the opioids epidemic, sending it to the full committee for their consideration.
• On April 24, the Trump administration renewed its 90-day emergency declaration regarding the ongoing opioid crisis. This is the second renewal since President Trump first declared the opioids epidemic a public health emergency in October 2017. The declaration extends the authority of federal health agencies to quickly hire more treatment specialists and reallocate resources to respond to the drug abuse epidemic.

National Guideline Clearinghouse Going Offline

The Agency for Healthcare Research and Quality National Guideline Clearinghouse web site will not be available after July 16 because federal funding through AHRQ will no longer be available to support it. The NGC is a repository of clinical practice guidelines.

Breastfeeding
On Friday, April 27, the House of Representatives voted to pass HR 4, the FAA Reauthorization Act. No, AWHONN hasn’t expanded the legislative and policy agenda to include regulating civil aviation. Rather, the FAA bill included provisions from HR 2375, the Friendly Airports for Mothers Act. This bill would direct large and medium hub airports to maintain a lactation area in each passenger terminal to provide a private and hygienic location for mothers to breastfeed their children.

AWHONN supports, protects, and promotes breastfeeding as the ideal and normative method for feeding infants, including the provision of human milk for preterm and other vulnerable newborns. Women should be encouraged and supported to exclusively breastfeed for the first six months of an infant’s life and continue to breastfeed for the first year and beyond. AWHONN partners with other maternal‐child health organization to improve cultural, institutional, and socioeconomic systems so that more women and newborns can experience the numerous physiologic and psychosocial benefits of breastfeeding. Our breastfeeding position statement can be reviewed here.

Abortion Care
According to a story in The Hill, Iowa lawmakers passed a bill on May 2 that would ban abortions once a heartbeat is detected in the fetus, effectively prohibiting the procedure by the sixth week of pregnancy. Gov. Kim Reynolds (R) has signed the bill. AWHONN’s position is that any woman’s reproductive health care decisions are best made by the informed woman in consultation with her health care provider. AWHONN believes these personal and private decisions are best made within a health care system whose providers respect the woman’s right to make her own decisions according to her personal values and preferences and to do so confidentially.

Therefore, AWHONN supports and promotes a woman’s right to evidence-based, accurate, and complete information and access to the full range of reproductive health care services. AWHONN opposes legislation and policies that limit a health care provider’s ability to counsel women as to the full range of options and to provide treatment and/or referrals, if necessary.

Title X Family Planning Programs
According to a story from Reuters, Planned Parenthood and the National Family Planning and Reproductive Health Association have filed lawsuits against the Trump administration to prevent the Title X Family Planning grant program from favoring groups that are faith-based and that promote abstinence. The lawsuits, which were filed in federal court in Washington, take aim at the guidelines the Department of Health and Human Services issued in February, which provided new criteria in evaluating applications for grants under the Title X family planning program.

Seth A. Chase is the director of government affairs at the Association of Women’s Health, Obstetric and Neonatal Nurses.

Sign up to get AWHONN Legislative Update delivered directly to your inbox every Monday when Congress is in session by sending an email to [email protected].

The sexual revolution began in 1960 with the emergence of a novel birth control for women in the form of a pill. Despite the increase in contraceptive options for women over the past 55 years (including many new long acting and reversible options), options for males have remained stagnant and have not progressed beyond the condom.

Although there have been attempts to create hormonal birth control for males, barriers persist. A recent study tested an inject-able male hormonal contraceptive (testosterone and progestin) with 266 male participants across 10 sites (Behre et al., 2016). These injections attempt to interrupt the normal hormonal cycle and decrease sperm count, rendering the male reversibly infertile (Ashbrook, 2016). The efficacy was 96%, a rate higher than OCPs(Oral Contraceptive Pills) for women (Ashbrook, 2016; Behre et al., 2016). Unfortunately, although the results were encouraging, the trial was abruptly halted last November due to reported side effects. Males reported acne, mood swings, and pain at injection site (Behre et al., 2016). Males also reported increased libido (Behre et al., 2016). Rationale for the discontinuation of the study has not been reported by the review board at the World Health Organization.

The reported side effects experienced by the males in the Behre et al. (2016) study mirror contraceptive side effects experienced by females. This further supports persisting patterns of cultural patriarchy in today’s science and reinforces cultural messages to the public that family planning and contraception is fundamentally a responsibility and burden placed solely on the female. While science may never occur without cultural bias, as personal beliefs and viewpoints tend to permeate our work (consciously or not), women’s health nurses can lend their support and voice to promote efforts to eradicate the androcentric bias in today’s contraceptive research.
As I become a nurse scientist, I am emboldened and hopeful, not deterred. I see opportunity for change in science, influenced by leaders in the nursing field. We must make a point to understand underlying biases in science and encourage nurses to have their voices heard. Only then can nurses advocate fully for the women they serve. Contraception is not just a women’s responsibility or burden, and we can change this paradigm starting now.

References
Ashbrook, T. (2016, November 4). Fresh controversy in male birth control. On Point.
Podcast retrieved from http://www.wbur.org/onpoint/2016/11/04/male-birth-control
Behre, H., Zitzmann, M., Anderson, R., Handelsman, D., Lestari, S., McLachlan, R. &
Colvard, D. (2016). Efficacy and safety of an injectable combination hormonal
contraceptive for men. Journal of Clinical Endocrinology and Metabolism.
Retrieved from http://press.endocrine.org/doi/pdf/10.1210/jc.2016-2141

Kate McNair is a women’s health nurse practitioner & PhD student at Boston College. She also maintains clinical practice as an OB/GYN RN at a community health center in Roxbury, MA. Follow her on Twitter @fem_nurse.

As a nurse with more than 20 years of obstetrical experience, I’ve had countless opportunities to advocate for patients one-on-one in a clinical setting. Ensuring that women and infants receive the best care possible is my passion.

In an effort to expand my advocacy efforts to a larger scale, I applied for and was selected to win a scholarship offered by AWHONN to attend in the Nurse in Washington Internship (NIWI). I was thrilled when I heard the news! NIWI is a three day conference in Washington, DC that prepares nurses to influence health care through the legislative process. The conference includes meetings with Members of Congress and their staff in which nurses share solutions for preventing maternal deaths, human trafficking, injuries to nurses on the job, and more. The scholarship covered my travel to DC and all of the costs associated with attending NIWI.

Almost 80 nurses from multiple practice areas and all parts of the country attended NIWI. It began with a 1 ½ day conference packed with presentations to prepare nurses as advocates, to understand the legislative process , and have a voice at the table. Participants were then grouped by state to meet with legislators, and charged with having a UNITED NURSING VOICE.

On the last day of NIWI, my Michigan colleagues and I spent hours on Capitol Hill visiting legislators and their staff. We used our conference learnings and crafted succinctly powerful talking-points touching on “The Heart” (a personal story), “The Head” (concrete reasons for support), and “The Health” (impact on society/individuals). As the day progressed, we had meetings with Senators Debbie Stabenow and Gary Peters, Congressman Tim Walberg, meetings with five Legislative Health Aids (two were from Congressman John Conyers office), and we watched a portion of a legislative hearing.

After a day of walking to and from the Senate and House of Representative offices, our FEET were on FIRE, but we were so excited! Nurses are a trusted, powerful force. Legislators and their staff, who make decisions that impact every part of our jobs, rarely have clinical expertise. They need US to tell them what’s happening “on the ground” so they can make the best decisions possible.

During our journey, we also met interesting people/groups on missions to meet legislators to ask for support/funding. Initially, I thought asking millions of dollars to continue funding Nursing Education ($244 million) and Research ($150 million) was an astronomical amount, however I quickly learned that it was not. We met one person who casually mentioned that he was on Capitol Hill to request ONE BILLION DOLLARS in funding! After I picked up my eyes off the floor, I remembered the resounding message from the NIWI presenters which stated, “If you’re not sitting at the dinner table, then you are on the MENU”. There’s a finite number of dollars for legislators to disperse, so nurses must use USE OUR VOICE TO ADVOCATE for funding/support, or risk being left without the resources we need to do our job.

My passion for advocacy grew tremendously during the Nurse In Washington Internship. I will continue to confidently speak to legislators and others when advocating for nursing, women’s health, newborns, and beyond. I will also remember to always wear flat shoes in DC :).

Resources

• Visit AWHONN’s Legsiative Action Center for more advocacy resources that YOU can use.
• Visit AWHONN’s website to see how AWHONN is advocating on your behalf.

Cheryl Larry-Osman, RN, MS, CNM
Cheryl Larry-Osman is a Perinatal Clinical Nurse Specialist at Henry Ford Hospital in Detroit, Michigan. She has 20 years of experience in obstetrics focusing in the clinical areas of Labor and Delivery, Postpartum, High Risk Antepartum, Normal Newborn, and Women’s Health. Cheryl is an advocate for the safe delivery of care for moms and babies & has participated in legislative action at the local, state, and national level.