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Health Care's Silver Lining

Abortion restrictions aside, the reform brings some good news for women and children.

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Thursday, April 01, 2010

For women's rights activists, fully embracing the newly, finally passed federal health care reform is a tough job.

While the law does not include the sweeping anti-abortion provisions pushed by political conservatives, it's still far from a pro-choice victory, given the executive order from President Obama that extends an existing ban on using federal funds to cover abortions. The White House defends that move as a simple maintenance of the status quo, which only allows public money to be used for abortions in cases of rape or incest, or when the mother's life is at risk. But frustrated choice supporters point out that, in fact, it expands the ban by applying it to any private insurer that participates in the new insurance "exchanges" and creates a cumbersome process of maintaining separate funds—public dollars that can't be used for abortions; private dollars that can—that might prompt some insurers to simply stop offering abortion coverage.

In a statement released the day the bill was passed by the House, Nancy Keenan, president of NARAL Pro-Choice America, said her group could not endorse the reform "because of the egregious abortion-coverage restrictions."

But like many women's rights groups, NARAL stopped well short of an outright condemnation of the entire reform package. "[B]ecause the measure has other very positive provisions for reproductive health, we couldn't in good conscience call for the bill's outright defeat and thus deny millions of American women and men the promise of better—although imperfect—access to health care services that are important to our pro-choice values," Keenan continued. "[W]e recognize that the bill will bring more than 30 million Americans into a system that includes affordable family-planning services, better access to contraception, and maternity care."

Among those victories are two provisions that are being applauded by women's and children's advocates—one that offers workplace protections for nursing mothers, and another that expands services for women with postpartum depression.

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Those provision have not garnered such a high level of immediate public interest as the abortion language; rather, they've remained somewhat buried in the bill—which clocks in at more than 2,400 pages—to be ferreted out by concerned advocates.

That includes Tanya Lieberman, a Northampton lactation consultant who writes a blog about breastfeeding issues for the Motherwear company. "Whatever you think of the health care bill passed by Congress yesterday, you may be pleased to hear that the bill extends a right to pump at work to moms in every state," Lieberman wrote on March 22.

The new law will require employers with at least 50 workers to provide nursing mothers with "a reasonable break time" and "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public." (The no-bathroom rule is an especially sweet victory for moms who've found themselves with no private place to pump other than a bathroom stall—leaving them to essentially prepare their babies' meals in the same place others are disposing of their own.)

Companies with fewer than 50 employees would be exempt if the requirement amounted to "an undue hardship." A woman will be guaranteed the right to a pumping spot for a year after the birth of her baby. "I'm not thrilled that it extends the right for only up to [one] year (I pumped longer for my son)," Lieberman wrote, "but what a huge difference this would make for mothers in the many states, mine included, that do not extend this right under state law!"

Massachusetts is one of 26 states that do not have any laws providing breastfeeding rights in the workplace, according to the National Conference of State Legislators. Much credit for the new federal guarantee goes to U.S. Rep. Carolyn Maloney, a New York Democrat who has pushed this and other pro-breastfeeding bills for years, and Sen. Jeff Merkley, an Oregon Democrat who supports promoting breastfeeding as a way to reduce health care costs and who got the provision into the health care bill.

The law has met with some grumbling from employer organizations unhappy over new government rules in the workplace. "Every additional mandated rule further burdens employers who are struggling to keep jobs afloat," Neil Trautwein, vice president of the National Retail Federation, told Kaiser Health News.

In fact, the law actually cuts employers a rather big break; as Lieberman noted, a provision initially introduced by Maloney that would allow women to sue employers who didn't comply with the requirement was dropped from the final version, removing any significant penalty for noncompliance. In contrast, Lieberman wrote, some states that already have laws guaranteeing workplace pumping have small penalties in place, such as fines. Such sanctions, she noted, are often enough to get employers to follow the law.

"For most employers this wouldn't really cost anything to implement," Lieberman continued, "and the benefits to them are significantly greater (less turnover and associated costs, higher morale, less health care costs, less absenteeism) [and] would greatly outweigh any cost."

Complaints from some employers aside, response to the law from advocates for women and children has been enthusiastic. "Wow! Has the word 'pumping' or 'breastfeeding' ever been in the language of a federal law before? I don't know," Melanie DeSilva, executive director of the Amherst-based non-profit MotherWoman, told the Advocate. "But what I do know is that from this point forward, when millions of mothers across America request time and an appropriate place to pump in the workplace, they now have the federal government on their side."

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The reform package includes another hard-won victory for women's advocates: the Melanie Blocker-Stokes Act, a postpartum-depression bill that's been kicking around the Capitol for seven years.

The bill is named after an Illinois mother who developed postpartum psychosis after the birth of her daughter in 2001. Despite medical interventions that included several short stays in psychiatric wards, Blocker-Stokes did not improve, and eventually committed suicide, jumping from a window ledge when her baby was three months old. While postpartum psychosis—the most serious of postpartum mood disorders—is relatively rare, advocates say that many more new mothers suffer from less dangerous but still serious forms of depression, which often go undiagnosed and untreated. According to the American Psychological Association, 800,000 women in the U.S. experience postpartum depression.

The provisions included in the new healthcare law "will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntary support service programs," announced Sen. Robert Menendez, a New Jersey Democrat, who sponsored the bill. The provision calls for $3 million in federal funding in fiscal 2010 for research on postpartum depression, public education and services for women with the condition, with "such sums as may be necessary for fiscal years 2011 and 2012."

"Millions of mothers nationwide who are suffering or will suffer from postpartum depression are among the winners as a result of the new health insurance reform law," continued Menendez. "These women understand that postpartum depression is serious and disabling, and that the support structure to help prepare for and overcome it has been woefully insufficient. We will attack postpartum depression on multiple fronts—with education, support, and research—so that new moms can feel supported and safe rather than scared and alone."

Health organizations including the American Psychological Association, the American Psychiatric Association, the American Congress of Obstetricians and Gynecologists, the American College of Nurse-Midwives and the March of Dimes have voiced their support of the Blockers-Stokes Act's inclusion in the healthcare package.

The federal law does not mandate universal screening of new mothers for postpartum depression, thus avoiding a topic that generates much controversy in discussions of postpartum mental health. In contrast, a proposed Massachusetts law, sponsored by Rep. Ellen Story (D-Amherst), would.

Story's bill calls for all new mothers to be screened a minimum of seven times, beginning in pregnancy and continuing through the first year of their children's lives, and would require insurance companies to cover the cost. The bill also calls on the Department of Public Health to train medical professionals on maternal depression, including screening techniques, and to strengthen postpartum support services.

While supporters of the bill say universal screening will circumvent the shame or stigma felt by mothers who are singled out for screening, the provision raises a number of red flags for others, including the Freedom Center, a Northampton organization that questions the validity of mainstream approaches to mental health and calls for a more holistic approach that empowers the person being treated. They see the mandatory screening component as a violation of privacy, and worry that the process could lead to an overdiagnosis of postpartum depression and an overuse of drugs as treatment—drugs, they say, that could be passed on to nursing infants, despite the lack of testing on their effects on children.

DeSilva of MotherWoman—which runs well-regarded postpartum programs, including facilitated support groups and training for medical professionals—sees the Blocker-Stokes law as an important public policy step. "The fact that the federal government has acknowledged postpartum depression—a major, largely underground, women's health care issue—and is putting significant funding towards research, education and support is massive," she said.

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