Keeping Women Barefoot And Pregnant

The Georgia legislature passed a law making abortion after six weeks of pregnancy illegal. I won’t go into all the details of the law. The theory is that a fetal heartbeat can be detected at that time. This is nonsense, because the embryo (it isn’t a fetus until nine weeks after conception) doesn’t have a heart at that point, although it does have a group of cells that, with luck, will become a heart and pulse together.

Pregnancies are defined from the last period, so six weeks is about when a period is late enough (for most women) that the woman starts thinking that maybe she’s pregnant. So the law bans all abortions. It also, and I haven’t dug into these details, makes it likely that women who have miscarriages can be convicted and imprisoned. Some asshole also said that it applies to ectopic pregnancies too, because the embryo/fetus should be removed from its unfortunate implantation outside the uterus and gently placed into that uterus. This is also nonsense – no such procedure has been developed.

Ohio wants to ban insurance coverage for abortion and most types of contraception. (Thanks, debbie!)

Alabama has also indulged in some sort of fuckery around a forced pregnancy law, but they haven’t gotten to voting on it yet.

The ACLU and others are challenging the Georgia law. At least two movie production companies are withdrawing from making movies in Georgia.

The responses on Twitter have been great. Here are some.

Great thread here – women will identify, and men should think about this.

At six weeks, the embryo is microscopic. A late and difficult period may well be an early miscarriage. Will the legislators want to examine menstrual fluid for those microscopic people?

You can donate to Planned Parenthood here. (thanks joel haines)

I think it’s cool that so many women are talking so candidly about menstruation and related matters.

Over to you all.

 

 








Aetna, CVS and data thoughts

CVS has agreed to buy Aetna for a lot of money. This raises a lot of questions including, what is the value proposition?

There is the obvious value proposition that CVS has 10,000 physical locations on the same information platform. I am spitballing and harkening back to my days as an insurance data geek and there are three inter-related items that could generate an incredible amount of revenue for the Aetna/insurance side of the deal. This is a risk adjustment data gold mine.
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Actions Have Consequences: Lysistrata Edition

I’ll just leave this here for your schadenfreude and viewing pleasure. Albo is quitting the Virginia House of Delegates.



Evidence based care in Medicaid

We want to do evidence based care.  We want to do things that work and avoid things that don’t work.  This sounds simple.  Let’s look at two very good natural experiments on unintended pregnancy rates:

Colorado:

    Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.

  • The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
  • When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
  • Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.

    • Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
  • The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.

More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else.  A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.

Texas

 

Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.

The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.

And guess what Congress will consider to be a high priority:

House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.

Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.

Evidence based policy making — Hoo Yaa



Why we can’t have success

The kids these days…

They’re more than alright… they, as a cohort, engage in far less dumb, risk seeking behavior than my cohort did at the same point in my life.

There are two major components of the decline. The first is that kids these days are far less stupid and idiotic and risk taking thrill seekers compared to twenty years ago. This would be Kevin Drum’s Lead hypothesis. As teenagers grow up with far lower exposures to known neurotoxins that impede judgement and encourage short term gratification, they use more judgement and think about the future a little more. They’re still teenagers but they are not stupid. Compared to my teen years, teens are having less sex. However over the past nine years, the amount of sex teens are having is fairly constant.

The other major component of the decline is far more frequent and effective contraception use. Guttmacher found that the entire decline in pregnancy rates among teens was the uptake in effective birth control utilization:

Sexual activity in the last 3 months did not change significantly from 2007 to 2012. Pregnancy risk declined among sexually active adolescent women (p = .046), with significant increases in the use of any method (78%–86%, p = .046) and multiple methods (26%–37%, p = .046). Use of highly effective methods increased significantly from 2007 to 2009 (38%–51%, p = .010). Overall, the PRI declined at an annual rate of 5.6% (p = .071) from 2007 to 2012 and correlated with birth and pregnancy rate declines. Decomposition estimated that this decline was entirely attributable to improvements in contraceptive use.

So the question going forward is whether or not we’ll see those trend lines break?

I think we will. The Federal government will go all in again on ineffective abstinence based misinformation. Essential health benefits will be redefined to exclude most highly effective birth control methods (oral hormones, IUDs, implants etc). Awareness of what works will decrease while access will decline. If we hold the amount of sex being had constant, that means more pregnancies.

I also predict that the older teens will see a lower bounce in their age adjusted pregnancy risk than younger teens. Older teens have some money, they have some knowledge of how to work the system and most importantly, the women who know that they are at high risk of unplanned pregnancy have had the ability to get long acting and reversible contraception (IUDs) to control their risk and maintain their autonomy. Younger teens in the Trump administration won’t have those advantages. I expect births to mothers under the age of 15 to increase at a higher rate than births to mothers at age 18.