The October 2001 issue of The Guttmacher Report on Public Policy, a bimonthly review from The Alan Guttmacher Institute's (AGI's) policy analysts, features these special analyses focused on policy issues and research key to reproductive health care.
RESEARCHERS WEIGH OPTIONS FOR MICROBICIDE DEVELOPMENT
Large-scale clinical trials are set to begin on a range of microbicidal compounds that women would apply topically to protect themselves against a range of sexually transmitted infections. But, according to a recent analysis, "As Research Accelerates, Focus Intensifies on Options for 'First-Generation' Microbicide," by Heather Boonstra, senior public policy associate with The Alan Guttmacher Institute (AGI), a product effective against HIV likely will not be available until 2007 at the earliest. The problems may be less scientific than practical: even in areas of the world that have relatively high rates of new HIV infections, clinical trials will need to involve many thousands of women; these trials will have to be mounted in resource-poor settings in developing-world countries without a strong research infrastructure.
Largely because of these challenges, Boonstra reports, some researchers are advancing a first-generation microbicide that would protect against pregnancy and at least one other STD but would not be tested and marketed for the prevention of HIV; doing so, they say, would demonstrate microbicides' "proof of concept" and help establish an initial market niche, primarily in the United States. Other researchers, meanwhile, remain undaunted in their pursuit of a microbicide against HIV, for use primarily by women in developing countries.
FAMILY PLANNING ACCESS JEOPARDIZED BY NEW MANAGED CARE RULES
A new set of managed care rules proposed by the Bush administration in August that aims to reduce demands on managed care plans and states could limit Medicaid recipients' access to family planning services, according to "Proposed New Rules for Medicaid Managed Care Could Impede Family Planning Access" by Rachel Benson Gold, deputy director for policy analysis at AGI. The administration's proposal would allow plans to not tell enrollees how to obtain information on counseling and referral services that the plan excludes on religious or moral grounds. Under the previous rules, plans could exclude counseling and referral services, but were required to tell enrollees how to access information about those excluded services. By not requiring plans to provide any information at the point of the actual clinical visit, the proposal has the very real potential to deny patients the information they need, at the moment they need it most.
NEW REPORT EXPLORES COMMUNITY HEALTH CENTERS' ABILITY TO MEET WOMEN'S FAMILY PLANNING NEEDS
Community health centers provided primary and preventive health care services to almost 10 million people last year, up from five million in 1990, according to "Community Health Centers and Family Planning: What We Know," by Cynthia Dailard, senior public policy associate with AGI. Last year, the centers operated 3,200 service sites in all 50 states, serving poor and low-income patients. Sixty-five percent of patients served by community health centers had income levels at or below the federal poverty level, and around 60% were minorities. Almost three in 10 were women of reproductive age.
Community health centers are private, nonprofit community-based organizations that are required by law to provide a wide array of affordable health services, including family planning services, to individuals living in medically underserved areas. With increasing numbers of low-income, uninsured individuals relying on community health centers for their health care, the analysis explores what is known about community health centers' ability to meet women's family planning and other reproductive health care needs.
NATIONAL POLICY ADVOCATED TO SECURE UNIVERSAL COVERAGE
Significant progress has been made since 1998, at both the state and national level, toward securing contraceptive coverage under private-sector insurance plans. But, according to "Federal Law Urged As Culmination of Contraceptive Insurance Coverage Campaign" by Susan Cohen, deputy director for government affairs with The Alan Guttmacher Institute, the lack of a comprehensive national policy creates a patchwork of coverage contingent on where a woman lives, the size of her employer, the type of insurance her employer offers and whether she obtains her insurance through an employer-based plan at all.
Nationally, Cohen reports, the federal government has acted to provide contraceptive coverage to all federal government employees, and at the state level, many state governments have required that insurance plans provide equitable treatment within existing prescription drug benefits. As a legal matter, the Equal Employment Opportunity Commission (EEOC) has issued a landmark decision that excluding prescription contraceptives from an otherwise comprehensive prescription drug plan constitutes illegal sex discrimination, and a federal court has ruled similarly based in part on the EEOC's reasoning. These developments have given new momentum to the drive, both among advocates and among key members of Congress, to enact the Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC), which would secure universal coverage for all women with insurance throughout the United States.