By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
EXECUTIVE SUMMARY
Results of a recent Phase III trial suggest that intravaginal dehydroepiandrosterone could provide women who cannot or do not wish to use intravaginal estrogen with an effective vaginal alternative for easing vaginal symptoms and pain with sex after menopause. The drug is under review by the Food and Drug Administration.
- In menopause, vaginal tissues atrophy, the lining thins and secretes less and less fluid, and the pH becomes more alkaline, which leads to discomfort with sex, as well as increased susceptibility to vaginal infections and urinary problems for many women.
- Providers offer moisturizers and lubricants as nonhormonal alternatives to intravaginal estrogen to temporarily ease pain with sex and provide moisture, but these treatments cannot correct the physical changes that produce the symptoms.
The most consequential reproductive health-related drama in Congress in 2016 most likely played out in January.
Conservative activists got their wish on Jan. 8, when President Obama was forced to veto legislation that would disqualify Planned Parenthood health centers from eligibility for federal funds, including Medicaid, for one year and that would repeal sweeping portions of the Affordable Care Act (ACA), including the major expansions of Medicaid adopted by 31 states and the District of Columbia and the federal subsidies intended to make private insurance affordable for low-income individuals and businesses.
The House had voted more than 50 times to repeal all or part of the ACA and had voted multiple times in 2015 to defund Planned Parenthood. By contrast, this legislation marked the first time the Senate has approved such provisions. The Senate used a special procedure that allowed for a simple majority vote, as opposed to the Senate’s usual 60-vote supermajority.
Congressional leaders will have an override vote that is yet to be scheduled as of the time of this writing, but everyone involved understands that vote is certain to fail. Rather, conservatives will use the veto to rally voters for the 2016 elections, which will bring to power a new president — perhaps one who would sign a similar bill into law.
Congressional observers expect extensive posturing and rhetoric during the election year, but it is unlikely that any major reproductive health-related legislation will be enacted. Instead, all eyes are on the U.S. Supreme Court, which is hearing major cases this term related to abortion and contraception.
ABORTION RIGHTS AT RISK
First up, with oral arguments scheduled for March 2, is the case of Whole Woman’s Health v. Cole, which is potentially the most important case on abortion since 1992’s landmark decision in Planned Parenthood v. Casey.
The case challenges the constitutionality of a Texas law designed to shut down access to abortion care in the state. The law does so by requiring that doctors who provide abortion services obtain admitting privileges at local hospitals and that healthcare facilities offering abortion care meet building specifications to essentially become mini-hospitals.
The plaintiffs in the case — along with their supporters, who filed 45 amicus briefs with the court1 — argue that the law is based on a sham premise: that it is needed to protect women’s health. Rather, as my Guttmacher Institute colleagues have argued, these types of restrictions actually harm women’s health and are designed to cut off access to legal abortion care.2
The Guttmacher Institute joined one of the amicus briefs, along with dozens of social scientists who research abortion safety, incidence, and access in the United States.3 Other briefs represent the perspectives of physicians, hospitals, public health specialists, constitutional scholars, abortion providers, individual women who have had abortions, business leaders, faith leaders, economists, historians, reproductive justice advocates, cities, states, 163 members of Congress, and the U.S. solicitor general on behalf of the federal government.
GUARANTEE DEBATE
Later in its spring 2016 term, the Supreme Court will hear arguments on seven challenges, collectively referred to as Zubik v. Burwell, to the ACA’s contraceptive coverage guarantee.
When the Obama administration implemented that provision of the ACA, it exempted houses of worship that object to sponsoring a health plan that includes contraceptive coverage. Furthermore, it set up an “accommodation” for nonprofit employers with religious objections, under which the employer does not have to pay or arrange for contraceptive coverage, while an insurance company must separately provide the employees and dependents with that coverage at no additional cost.
The Supreme Court first addressed the issue in its 2014 decision in Burwell v. Hobby Lobby Stores, which effectively required the administration to extend its accommodation to certain for-profit companies.
In Zubik, the plaintiffs are challenging the accommodation itself and are arguing that the process, under which they must fill out a form to tell their insurance company or the federal government that they have a religious objection, makes them complicit in the coverage they find objectionable.
At stake might be contraceptive coverage for hundreds of thousands of U.S. women. According to a 2015 study from the Kaiser Family Foundation, an estimated 3% of nonprofits offering health insurance, and 10% of the largest such nonprofits, had taken up the accommodation.4
Decisions in both cases are likely to be issued in the waning days of June 2016. However the members of the Supreme Court rule in each of the cases, the decisions will affect access to abortion and contraceptive care nationwide and reverberate politically in the fall elections, as well as in Congress and state legislatures in the years to come.
REFERENCES
- Center for Reproductive Rights. Amicus Briefs in Support of Whole Woman’s Health. Accessed at http://bit.ly/1SxfEib.
- Gold RB, Nash E. TRAP laws gain political traction while abortion clinics — and the women they serve — pay the price. Guttmacher Policy Review 2013; 16(2):7-12.
- Whole Women’s Health v. Cole. Brief for Social Science Researchers as Amici Curiae in Support of Petitioners. Accessed at http://bit.ly/1VFIDQF.
- Sobel L, Rae M, Salganicoff A. Data note: Are nonprofits requesting an accommodation for contraceptive coverage? Accessed at http://kaiserf.am/1NFPeL3.
