ARHP concurs with the definition of reproductive health articulated both in the 1994 International Conference on Population Development and reaffirmed at the Beijing (Fourth) World Conference on Women. The basic ICPD definition reads:
"Reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system and to its functions and processes. It implies that people have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice…. Reproductive health care also includes sexual health, the purpose of which is the enhancement of life and personal relations."
From this, ARHP leaders advocate the following positions on specific aspects of reproductive health:
ABORTION
Abortion care is a critical component of comprehensive reproductive health care. ARHP supports a woman’s right to choose to have an abortion, just as we support her right to choose to become a parent or to carry an unintended pregnancy to term and choose adoption. The topic areas below represent ARHP’s positions on the range of ways in which a woman’s access to abortion care can be affected.
Topic areas below include:
- Medical Advancement and Provider Training in Abortion
- Medical Misinformation about Abortion
- Legal Access to Abortion and Abortion Policy
- Financial Access to Abortion in the United States
- Violence Against Abortion Providers
Medical Advancement and Provider Training in Abortion
ARHP’s members include physicians and clinicians who provide abortion care. Cutting edge technologies in abortion care and excellence in provider training are a priority for ARHP and our members. Through supporting new technologies and increasing provider training, ARHP hopes to address the current shortage in abortion providers in the U.S. and the need for more and improved options for women seeking to terminate a pregnancy.
Medical Education and Provider Training
One barrier to abortion access is the lack of trained providers of abortion care in the United States. Abortion education needs to be a standard component of medical education in all accredited institutions. Abortion training should be available to all, with exceptions only to meet the needs of individuals whose personal beliefs preclude them from providing abortion services.
Advancement in New Abortion Technologies
ARHP encourages the investment of public and private funding for basic and clinical research to develop further improved abortion technologies.
ARHP endorses the FDA’s approval of mifepristone (trade name Mifeprex) for the termination of early pregnancy in 2000. Mifepristone is currently the only form of medical abortion approved by the FDA. ARHP supports advances in and access to abortion technologies.
According to the Guttmacher Institute , since its approval, use of mifepristone has increased steadily among providers, even as abortion rates have declined overall and reproductive health providers who did not previously offer surgical abortion care report currently offering medical abortion. ARHP is encouraged to see an increase in the number of abortion providers since mifepristone’s availability. According to Guttmacher Institute’s analysis, the decline in abortion providers slowed dramatically between 2000-2005. It declined 2% during that period – but would have declined 8% without the increase in the number of providers that offer only medical abortion services.
Medical Misinformation about Abortion
ARHP is foremost governed by evidence-based information and practices. We are troubled by the anti-choice movement’s continued dissemination of medical misinformation about abortion. In addition to spreading misinformation through organizational materials and public websites, the anti-choice movement has been successful in inserting medical misinformation into required patient materials under mandatory counseling laws. The spread of medical misinformation about risks associated with abortion and specific abortion procedures is a dishonest attempt to bolster legal and legislative efforts to restrict access to abortion. The anti-choice movement often advertises abortion myths under the guise of “protecting women from abortion” but, in reality, perpetuating misinformation about abortion only puts women at risk.
Because medical misinformation about abortion is so widespread, and sometimes even distributed by state and federal government agencies, ARHP applauds efforts by the media to dispel myths about abortion. We encourage members of the press to commit to evidence-based reporting about abortion given the vigorous and deliberate efforts by the anti-choice movement to confuse and distort medical information about abortion in the public’s eye.
To learn more about recurring myths about abortion put forward by the anti-choice movement, click here .
Legal Access to Abortion and Abortion Policy
ARHP supports the legal right of a woman to obtain an abortion. ARHP supports the United States Supreme Court decision, Roe v. Wade, and opposes any legislation, regulation, or Constitutional amendment that weakens this decision and/or intervenes in medical decision-making regarding abortion. Roe v. Wade made it legal, and therefore safe, for a woman to choose abortion. Prior to Roe v. Wade, women successfully obtained abortions on a regular basis, but often at the expense of her own health and life. Today, in countries where abortion is illegal, women continue to obtain abortions at high rates and often under unsafe circumstances. Abortion has always taken place regardless of its legal status; legalization simply allows a woman to obtain her abortion in a medical setting under safe circumstances.
The anti-choice movement continues its campaign of restricting access to abortion and ultimately eliminating the laws that protect a woman’s right to choose.
Abortion Bans
The decision to continue or terminate a pregnancy belongs to the pregnant woman. ARHP opposes any judicial, legislative or administrative attempt at the local, state, or federal levels to ban any abortion procedure or medical procedure to terminate a pregnancy.
Adolescent Access
Adolescents have the right to sexual and reproductive health information and services. While parental involvement in the provision of reproductive health care services for minors is desirable and should be encouraged, it may not always be feasible or in the best interest of the minor, and it should not be legislatively required. Proponents of parental notification laws claim that these laws are necessary to ensure family communication takes place when a teen is facing an unplanned pregnancy or is considering abortion. However, studies show, in the absence of mandated involvement, more than 60% of adolescents under age 18 seek the advice and/or support of at least one parent in their abortion decision. That figure increases among 14- and 15-year olds to 90% and 75%, respectively.[1] It is vital that abortion and other reproductive health services for minors be accessible, affordable, safe, and confidential.
Mandatory Waiting Periods and Counseling
ARHP opposes requirements for mandatory waiting periods and government-scripted counseling messages for abortion. Such requirements are characterized by their proponents as attempts to help or protect women when, in fact, they are designed to discourage, delay, or dissuade a woman from obtaining an abortion. Mandatory waiting periods also only serve to delay an abortion by days or weeks, even though we know obtaining an abortion is safest during the earliest part of the first trimester.
Imposing a mandatory waiting period that requires a woman to wait any period of time between her request for and her ability to obtain an abortion is government interference in personal medical decision-making. ARHP is opposed to any government attempt to interfere in the timing and decision-making around abortion. Such decisions must be left to patients to make in consultation with their health care providers.
Women seeking medical advice on reproductive health issues must be given complete information on all reproductive choices, including pregnancy termination options without coercion. ARHP opposes requiring health care providers to read government-scripted lectures to patients. Such scripts are medically unnecessary and often contain medical misinformation disseminated by the anti-choice movement. We also oppose restrictions on what information a health care provider may provide to a patient. Whether governmentally or institutionally imposed, such “required counseling” and/or speech bans interfere with a woman’s relationship with her health care provider and the ability of the provider and patient to determine the best treatment for the patient. Health care providers are trained to determine what information is relevant to a patient's medical situation and hold themselves accountable for providing comprehensive information and services. Restricting or requiring speech undermines the professional standards that health care providers hold themselves to and implies that the patient's needs are not already the top priority for the provider."
Refusal Clauses
While ARHP respects an individual providers religious or moral beliefs, those beliefs must not limit the scope or the quality of health care available to patients. Health care providers who do not provide abortion services on moral or religious grounds have a professional obligation to provide their patients with up-front, clear advertising that these services are not available from the provider and a timely referral to another health professional known to provide such services. ARHP also opposes restrictions on reproductive health services and benefits imposed by faith-based hospitals and institutions.
Targeted Regulation of Abortion Providers or TRAP Laws
ARHP is opposed to any laws that target the medical practices or facilities of health care professionals that provide abortion care and impose legal requirements that are different or stricter than requirements imposed on other medical facilities. Such requirements are designed to harass abortion providers under the guise of patient safety. Because they create additional costs and expenditures for abortion providers, thereby making abortions more expensive and less available, such laws are also an infringement on a woman’s right to access an abortion.
US Foreign Policy on Abortion/Global Gag Rule
ARHP opposes the 'global gag rule' regulation on the grounds that no health care provider should be prevented from giving information about safe and clinically appropriate options for women. Policies that prevent health care providers from discussing these options or providing related services violate free speech and jeopardize the lives and health of women and their families.
Financial Access to Abortion in the United States
Public Funding for and Insurance Coverage of Abortion
All women, regardless of insurance status or coverage, must have full and equal access to abortion services. Private insurers should reimburse the cost of abortion services according to the same guidelines established for other, routinely-covered medical and surgical care. Publicly funded health services, such as Medicaid and health plans covering government employees and the military, must not discriminate against women by denying coverage for the provision of abortion services.
ARHP opposes the Hyde Amendment which excludes abortion from health care services provided to low-income people by the federal government through Medicaid. Any state or federal restriction on public funding for abortion care amounts to discrimination against poor women in health care coverage and should be repealed.
ARHP opposes laws restricting coverage of abortion services for federal employees including women in the military and female dependents of men in the military. ARHP opposes state laws prohibiting private insurers from covering abortion care services and opposes state bans on abortion coverage in public employees’ insurance policies.
Violence Against Abortion Providers
ARHP is concerned about the history of violence aimed at abortion providers and abortion care facilities in the United States. The use of violence and/or force to achieve a political or religious goal is appalling and should be thoroughly investigated by law enforcement officials and promptly prosecuted. Local, state, and federal government institutions should show zero tolerance for violent activities meant to terrorize a subset of the medical profession.
Reference
- Abma JC, Martinez GM, Mosher WD, Dawson BS, Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002. Hyattsville, MD. Vital Health Statistics; Vol 23 no 24. National Center for Health Statistics: 2004.
ARHP’s Position Statement on abortion was modified and approved by Policy Committee, May 2008
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CLONING
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
Recognizing that cloning raises important and complicated medical and ethical questions, ARHP encourages open and inclusive dialogue on all aspects of the technology and its potential.
Reproductive Cloning
- While ARHP acknowledges the intense desire of infertile couples for a genetically related child or children, and supports reproductive choice, overwhelming scientific evidence (as summarized in the 2002 National Academies of Science report) shows that cloning is not a safe procedure for human reproduction at this time [1].
Therapeutic Cloning and Stem Cell Research
- Therapeutic or 'research' cloning is a viable form of scientific research and should remain legal.
- Stem cell research holds enormous promise for advancing our fundamental knowledge of human physiology and our ability to develop new, safe and effective treatments for disease and injury, ARHP supports both basic and applied research utilizing stem cells from embryos created for research purposes (therapeutic cloning) as well as from adults. Considering the preliminary state of knowledge in this field, embryonic stem cell research should not be restricted or deferred in the hope that therapeutic goals can be achieved solely through research using adult stem cells.
- In order to address the many concerns surrounding this research, effective guidelines for the conduct and regulation of therapeutic cloning must be developed with the ongoing input and oversight of a broad constituency.
- Clinical and ethical standards must be maintained to protect the well-being, rights and dignity of clinical trial participants and future patient
Reference
- "Scientific and Medical Aspects of Human Reproductive Cloning," available from the National Academy Press.
ARHP's Cloning statement was approved by ARHP's executive committee on August 22, 2002 and recommended by ARHP's policy committee on May 24, 2002.
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CONTRACEPTION
Contraceptives are pregnancy prevention methods effective prior to implantation. All individuals have the right to safe, effective, affordable, and accessible contraception and contraceptive counseling. Contraception is an essential and basic preventive health service; it reduces the number of unintended pregnancies and thus the need for abortion. ARHP, along with every major leading medical group in the United States including the American Medical Association, the American College of Obstetricians and Gynecologists, the American Medical Women’s Association, the American Society for Reproductive Medicine, and the Society for Adolescent Medicine, support access to reliable contraception as a part of basic health care including access to accurate, comprehensive, and unbiased information and the full range of safe and reliable contraceptive options.
Because of their unique reproductive capacities, women most often bear the burdens stemming from inadequate access to contraception. Whether or not a woman has access to contraception directly affects her ability to plan whether and when to have a family. This has an impact on every aspect of her life including her socio-economic, educational, and professional status and the health and well-being of the woman and her family. The topic areas below represent ARHP’s positions on the range of ways in which a woman’s access to contraception can be affected.
Topic areas below include:
- Provider Education and Contraceptive Services in the Health Care Setting
- Contraceptive Equity/Insurance Coverage
- Public Funding for Contraceptive Services
- Teens’ Access to Contraception
- New Contraceptive Technologies
- Emergency Contraception
Provider Education and Contraceptive Services in the Health Care Setting
Provider Education
Health care providers play a critical role in making contraception available by educating health care consumers about their contraceptive options and helping patients understand what option will be best for them. As an integral part of their education, every health care provider should learn about all contraceptive methods, how to counsel patients about their contraceptive choices, and best practices in providing contraception. Specifically, any physician, advanced practice clinician, and pharmacist who encounter women and/or teens at any entry point in the health care system should have access to and pursue medical education on providing comprehensive, un-biased and culturally competent contraceptive services.
Refusals of Service and Information
An individual provider's religious or moral beliefs must not impair the quality of medical care available to a patient. Statutory "conscience clauses" and "refusal clauses" pertaining to health care providers, including pharmacists, must not be allowed to deny or impair the access of women or men to legal reproductive health services, procedures, and medications. Health care providers who do not provide contraception on moral or religious grounds have a professional obligation to provide their patients with a timely referral to another medical professional known to provide such services, and to inform their patients that they are being referred because of the provider's personal beliefs, not for professional or medical reasons. Such providers have a responsibility to the public to choose professional careers that are less likely to require that they provide a full spectrum of reproductive services that would be considered the medical community standard.
Contraceptive Equity/Insurance Coverage
Whether a woman has access to contraception often depends on her ability to access it financially and whether or not her insurance plan covers the range of FDA approved prescription contraceptive methods. According to the Guttmacher Institute, “approximately 62 million women are of childbearing age and the typical woman only wants 2 children. This means a woman will have to use contraception for roughly 3 decades to achieve that goal.” Even though this clear basic health care need exists, some private insurance companies do not cover contraceptive costs, even when they cover other prescription drugs or devices to prevent medical conditions, and many states do not have laws requiring private insurers to do so.
These barriers exist even in the face of strong legal precedent that says denial of contraceptives in insurance plans that cover drugs and devices for other medical conditions constitutes discrimination against a woman based on her ability to become pregnant under the Pregnancy Discrimination Act. The Equal Employment Opportunity Commission (EEOC) ruled in 2000 that employers may not discriminate against women in their health insurance plans by denying benefits for prescription contraceptives, if they provide benefits for drugs, devices and services used to prevent other medical conditions. The EEOC ruling included the provision that "coverage must extend to the full range of prescription contraceptive choices. Because the health needs of women may change – and because different women may need different prescription contraceptives at different times in their lives – [the employer] must cover each of the available options for prescription contraception."[1]
Out-of-pocket expenses and/or a woman’s inability to financially obtain the method of her choice can lead to discontinued or inconsistent contraceptive use and could result in an increased rate of unintended pregnancies. ARHP supports state legislation that would require contraceptive equity in private insurance plans without exemptions for certain institutions. ARHP also urges congress to pass the Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC) which ensures access to contraception by prohibiting health insurance plans that provide prescription drugs, and devices from excluding coverage of FDA-approved prescription contraceptive drugs and devices (including hormonal contraceptives, diaphragms, cervical caps and intrauterine devices.)
Requiring contraceptive equity in private insurance plans is a cost-effective way to guarantee that providers can offer the range of contraceptive services to women and their families and will help decrease the rate of unintended pregnancy in the United States.
Public Funding for Contraceptive Services
Many women, men, and teens are in need of contraceptive services but cannot afford them. Through Medicaid, Title X funding and other federal and state funding programs, millions receive contraceptive care. ARHP supports public funding for contraceptive counseling and services and encourages states and the federal government to prioritize resources in order to build on current funding levels.
Current public funding levels have been under attack by social conservatives at the state and federal levels for years and, as a result, funding levels for family planning services have been cut or have not increased along with inflation - forcing many clinics that serve poor populations to make cuts in services. ARHP opposes attempts to cut or restrict public funding for contraceptive services and encourages health care providers, policymakers, and advocacy organizations of all opinions to consider contraceptive services a fundamental investment in public health and a cost-effective way to reduce unintended pregnancies.
Teens’ Access to Contraception
ARHP supports providing confidential contraceptive counseling and services to teens as part of a comprehensive approach to sound adolescent reproductive health care including reducing teen pregnancy and sexually transmitted infections (STIs) among teens.
Over half of all teens in the United States will have intercourse before high school graduation. ARHP opposes state parental consent and/or notification laws for contraceptive services for minors. Such laws do not prevent teens from having sex but do discourage them from seeking contraceptive information, counseling and services. Effective parental-teen communication around sexuality is the ideal but not every young person has a trusted adult to turn to for information. Confidential contraceptive care for teens is essential, and should be protected by law, if health care providers are to effectively play their role in providing the best possible adolescent health care and ensuring good reproductive health outcomes for young people.
New Contraceptive Technologies
Because everyone’s needs are unique, ARHP supports the availability of all safe, effective contraceptive options, including reversible and permanent methods. ARHP encourages the continued investment in expanding contraceptive options by identifying new, safe, and effective methods of family planning, including methods that also provide protection from sexually transmitted infections. Making new safe and effective contraceptive technologies available, and training providers in these methods, is paramount in helping women and men plan their families and is vital to building a stable, functional health care system in the United States.
In order to realize new contraceptive technologies it is essential for government bodies, policymakers, and private companies to demonstrate the political and financial will necessary to expand and fund the research and development of new technologies for both men and women.
Emergency Contraception
Emergency contraception (EC) refers to a group of safe, effective methods that women can use to prevent unintended pregnancy after unprotected or unwanted sex. EC methods available in the United States include emergency contraceptive pills (ECPs) and the copper-T IUD (ParaGard). ARHP encourages education about and promotion of access to EC. ARHP supports the distribution of EC as ECPs containing levonorgestrel (brand name Plan B®) over-the-counter (OTC) without delay or discrimination. ARHP also supports mandates at the state, local, and institutional levels requiring hospitals and emergency rooms to provide rape and sexual assault victims with EC as standard operating procedure. Plan B meets the U.S. Food and Drug Administration’s (FDA) standards for making a drug available without a prescription. Plan B is safe and effective for women and teens. It is not associated with harmful side-effects or dangerous when taken with pre-existing medical conditions. It is also easy for all reproductive-age women to self-diagnose her own need for Plan B, which is required by the FDA for OTC designation. In 2004, the FDA's own panel of experts recommended that Plan B be available OTC for everyone. In August of 2006 the FDA approved Plan B for use for women ages 18 and older without prescription. FDA approved labeling includes two pills separated by twelve hours for use over 72 hours. Only teenage women 17 and younger are required to get a prescription in order to obtain Plan B. Because Plan B is available without a prescription only to women ages 18 and older, proof of age/identification is required to obtain it; therefore, it is kept behind-the-counter at pharmacies. ARHP opposes an age restriction on Plan B, and the resulting behind-the-counter status at pharmacies, for the following reasons:
Imposing an age restriction on Plan B puts American teens at increased and unnecessary risk for unintended pregnancy. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 50% of teenagers have sex before graduating from high school and over 700,000 teenage girls in the United States become pregnant every year. If taken within 24 hours after unprotected sexual intercourse, EC is about 95% effective in reducing the risk of pregnancy. This drops to between 75% and 89% if EC is taken between 24 and 72 hours. EC can still reduce the chance of pregnancy if taken up to 120 hours after unprotected intercourse, but the effectiveness decreases as time passes. 1 Requiring teens to get a prescription means they may not be able to obtain it in a timely manner thereby increasing their risk for unintended pregnancy and related consequences.
Requiring proof of age/identification to obtain Plan B creates barriers for immigrant women. Individuals must show identification for proof of age in order to obtain Plan B at a pharmacy. Many immigrant men and women do not have government-issued identification and therefore can not obtain EC.
Keeping Plan B behind-the-counter allows pharmacists to refuse anyone access to EC. Since the availability of Plan B behind-the-counter, hundreds of women have reported being refused access to EC by a pharmacist or have been unable to find a pharmacy that stocks Plan B. ARHP strongly opposes refusing access to EC based on personal objections or institutional policies. Refusing access to EC puts women at risk for unintended pregnancy. It also puts individual pharmacists' personal beliefs ahead of women's health, rights, and safety, which ARHP considers negligence and betrayal of the professional responsibility of a health care provider.
Based on published research it has become common practice for reproductive health providers to recommend Plan B up to 120 hours after unprotected intercourse (although earlier is better), and to use both pills at the same time. ARHP encourages the FDA to reconsider the current labeling limitation of 72 hours.
ARHP strongly encourages all providers to discuss EC with female patients of all ages so women and teens have the information they need to prevent pregnancy after unprotected or unwanted intercourse. Primary care providers are encouraged to integrate discussions of contraception and EC into patient encounters to reduce risk of unintended pregnancies under circumstances of medical risk, e.g., when potentially teratogenic medications are given or when substance abuse is an identified problem. In particular, ARHP encourages providers who serve adolescents to discuss EC with them to ensure young people know that this method of pregnancy prevention is available and that they have confidential access to services and information regarding EC.
Since the FDA approved Plan B replace for women 18 and older, sales have doubled proving that eliminating barriers improves access. ARHP encourages the FDA to remove the age restriction on Plan B in order to prevent as many unintended pregnancies, and their consequences, as possible.
Reference
- Equal Employment Opportunity Commission (EEOC), Decision on Coverage of Contraception (Dec. 14, 2000); at http://www.eeoc.gov/policy/docs/decision-contraception.html
ARHP's Position Statement on Contraceptive Access was approved by Policy Committee, May 2008.
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HIV/AIDS
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
HIV/AIDS is an international health crisis, affecting millions of men, women, and children throughout the world [1].
Because of the intensity of the HIV/AIDS epidemic, public education programs that use a combination of approaches to prevent HIV/AIDS transmission are essential.
- Promoting abstinence is a useful and important way to prevent the transmission of HIV/AIDS; promoting abstinence at the expense of education about effective condom use can only increase the incidence of HIV/AIDS. Educational programs should highlight the fact that the consistent and correct use of condoms during sexual activity is very effective in preventing the spread of HIV/AIDS [2]. Educational programs should also highlight the fact that abstinence is not an option for many populations at risk for HIV/AIDS-notably women with limited power-who may not be able to delay initiation of sex or limit their number of sexual partners.
- Comprehensive school-based HIV/AIDS education that is appropriate to students' age and developmental level is an essential part of education programs. Effective programs respect the diversity of values and beliefs represented in the community and complement and augment the HIV/AIDS education children receive from their families.
- Effective school-based HIV/AIDS education curricula provide comprehensive, medically accurate information on sexual and reproductive behavior and health. ARHP supports abstinence education as a component of an overall HIV/AIDS prevention strategy, and recommends that abstinence be taught in the context of a comprehensive program of sexuality education so that individuals have all the information they need to make safe and informed choices about their sexual behavior.
- Within public education programs, particular emphasis should be placed on special populations most at risk for HIV/AIDS in the United States and abroad.
Education about HIV/AIDS is essential for all health care professionals. In addition to factual information related to the diagnosis and care of patients with HIV/AIDS, curricula should include ethical discussions that remove stigma and moral judgments about individuals with HIV/AIDS, as well as training on how to educate patients about HIV/AIDS prevention.
Needle exchange programs can be an effective tool for decreasing the transmission of HIV/AIDS.
All individuals, regardless of insurance status or coverage, should have full and equal access to available HIV/AIDS treatments.
Because HIV/AIDS-related discrimination and stigma often prevent individuals from receiving adequate treatment and support, ARHP advocates respect and protection for individuals with HIV/AIDS and their families, friends, and intimate partners.
Because HIV/AIDS is so prevalent and treatment options are limited, ARHP encourages the investment of public and private funding for basic and clinical research to develop new preventive strategies and treatments.
References
- UNAIDS, December 2002. www.unaids.org/worldaidsday/2002/press/update/epiupdate_en.pdf.
- Warner DL. Male condoms. In: Hatcher RA, Trussell J, Stewart F, et al (eds): Contraceptive Technology, Seventeenth Revised Edition. New York: Ardent Media, 1998, pp. 325-355.
ARHP's HIV/AIDS statement was approved by ARHP's board of directors on June 7, 2003 and recommended by ARHP's policy committee on May 19, 2003.
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HUMAN PAPILLOMAVIRUS AND CERVICAL CANCER
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
Vaccines for human papillomavirus (HPV) represent the next major breakthrough in prevention of cancer and sexually transmitted infections. The Association of Reproductive Health Professionals (ARHP) supports the development of and widespread access to HPV vaccines as part of a comprehensive prevention screening and treatment strategy for cervical cancer and other HPV-related conditions, such as genital warts. HPV vaccines will be able to prevent some of the most virulent strains of HPV that cause cervical cancer and genital warts.
Cervical cancer has become the second most common female malignancy worldwide and kills nearly 250,000 women each year.[1,2] In the United States alone, every year close to 12,000 women are diagnosed with cervical cancer, resulting in 4,000 deaths.[3] Nearly half of the women who are diagnosed with cervical cancer in the United States have not been properly screened.[4] For this reason, routine visits to a health care provider for ongoing surveillance remain a critical component in the fight against cervical cancer. ARHP encourages health care providers to adopt screening for HPV using the latest technologies available, including the liquid-based Pap test and HPV DNA testing, for all appropriate candidates.
ARHP encourages HPV vaccines to become the standard of care. ARHP supports the recommendation of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) that HPV vaccines be added to the routine schedule for girls and women throughout the age ranges as deemed appropriate by ACIP. ARHP supports the vaccines’ placement on CDC’s “Vaccines for Children” program, which helps ensure that girls from low-income families are immunized. ARHP strongly encourages all states within the United States to adopt vaccination policies to ensure that all people can easily access this important method of prevention.
ARHP supports and encourages access to HPV and cervical cancer prevention, screening, and treatment for women and girls, regardless of age, race, ethnicity, income, sexual orientation, or immigration status. Although HPV vaccines are important developments in efforts to eradicate cervical cancer and genital warts, disparities in access to health care continue to be a public health challenge. Lack of access leaves many girls and women without regular and adequate preventive health care services. To encourage equal access to these technologies by all people who need them, ARHP supports private insurance coverage and public funding for the vaccines and related prevention, screening, and treatment technologies and encourages the US Department of Health and Human Services to make the vaccines available through the Title X program initiative.
HPV vaccines can be effective only if providers and the public are educated about their safety and efficacy and are encouraged to offer and receive them. ARHP supports provider training for the vaccine and related screening and treatment technologies and their incorporation into practice and for public education about the benefits of these new tools. While vaccines offer a new approach to preventing HPV and cervical cancer, ARHP encourages health care providers to continue promoting safe sex practices and choices to their patients.
- Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113(3):214-26.
- Sawaya GF, Brown AD, Washington AE, Garber AM. Clinical practice. Current approaches to cervical cancer screening. N Engl J Med 2001;344:1603-7.
- American Cancer Society. (2004, accessed October 27, 2004) Cancer Facts & Figures 2004. [Online] www.cancer.org/downloads/STT/CAFF_FinalPWSecured.pdf.
- National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14:1-38.
ARHP's position statement on HPV and cervical cancer was recommended by ARHP's policy committee on August 25, 2006 and approved by ARHP's board of directors on September 6, 2006.
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IMPROVING HEALTH CARE ACCESS AND PATIENT CARE THROUGH COLLABORATIVE PRACTICE
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
ARHP supports the provision of reproductive health care services by all qualified health care providers. A multidisciplinary approach to health care is cost-effective, results in the best patient care, and increases the availability of needed health services.
Physician-only laws—many of which were created prior to the emergence of nurse practitioners and physician assistants—often impose unnecessary legal barriers to quality health care.
Quality of patient care is enhanced when a team of health care providers works together with mutual respect, trust, and professional integrity to create a practice that draws upon the strengths of a variety of professional groups and specialties. Multi-disciplinary practice methods can contribute significantly to increasing access and containing costs.
ARHP also supports prescriptive authority and equitable reimbursement for all appropriately trained and qualified health care providers—such as physician assistants, nurse practitioners, nurse midwives, and pharmacists—within their practice specialty. The ability of these individuals to prescribe controlled drugs is essential to providing efficient, cost-effective, quality health care. All clinicians must be guided by their training, experience, and standards of care that reflect the most current research, technology, and clinical guidelines.
ARHP's Improving Health Care Access and Patient Care Through Collaborative Practice position statement was revised and approved by ARHP's board of directors on June 3, 2006.
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SCREENING AND PREVENTION OF REPRODUCTIVE CANCERS AND BREAST CANCER
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
ARHP supports successful, evidence-based strategies that reduce the incidence, morbidity, and mortality of reproductive cancers and breast cancer.
Federal funding for high quality, peer-reviewed research and public information campaigns about the risk factors of reproductive cancers and breast cancer should remain a priority.
Since certain cancers exclusively affect women, are more prevalent in women than in men, or affect women differently than they do men, it is important that clinical research address these differences.
ARHP supports policies that seek to reduce disparities in reproductive cancers and breast cancer survival rates among individuals of varying ethnic backgrounds and socio-economic status. All individuals deserve quality care, access to high-quality clinical trials, psychosocial support, and follow-up treatment.
Genetic testing for reproductive cancers and breast cancer has potentially advantageous as well as potentially harmful effects. ARHP supports an open discussion between women and their health care providers about the benefits and risks associated with genetic testing.
Breast Cancer
The highest quality studies and expert consensus show there is no causal link between induced and spontaneous abortion and risk for breast cancer. ARHP supports public policy efforts that inform individuals about this evidence.
Since there is no scientific evidence that breast self-exam saves lives or enables women to detect breast cancer at earlier stages, ARHP does not recommend for or against the practice of breast self-exam. The decision to practice breast self-exam should be made by individuals who are appropriately informed about this activity from their health care providers.
ARHP's Screening and Prevention of Reproductive Cancers and Breast Cancer statement was approved by ARHP's board of directors on June 7, 2003.
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SEXUALITY AND SEX EDUCATION
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
Sexual expression is a normal and healthy part of human behavior. Parents, health care providers, and educators each have a role in providing comprehensive, accurate, age-appropriate information about the many facets of sexuality to all people, regardless of age, race, sexual orientation, sexual preference or income.
Attitudes, beliefs and values about sexuality, intimacy, relationships and identity form over a lifetime. Good sexuality education encompasses sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles in a person's thoughts, feelings and actions.
Parents and other responsible adults are encouraged to learn more about positive and productive ways to discuss sexuality and to initiate discussions of sexuality with children in their care.
Healthcare providers can provide important information on sexuality and reproductive health, and need to be able to communicate this information without restriction to patients in private. This includes the provision of sexuality information and healthcare to minors without parental consent or notification.
Comprehensive school-based sex education that is appropriate to students' age and developmental level is an essential part of education programs for every age. Effective programs respect the diversity of values and beliefs represented in the community and complement and augment the sexuality education children receive from their families. In this way, comprehensive sexuality education programs help young people develop positive views of sexuality, give them accurate information regarding health and sexuality, and assist them in acquiring the skills to make healthy decisions regarding their own sexuality now and in the future.
Effective school-based sex educational curricula provide comprehensive, medically accurate information on sexual and reproductive behavior and health. While ARHP supports an individual's decision to abstain from sexual activity, it recommends that abstinence be taught only in the context of a comprehensive program of sexuality education in order to enable all individuals to make safe and informed choices about their sexual behavior.
ARHP's Sexuality and Sex Education statement was approved by ARHP's executive committee on August 22, 2002 and recommended by ARHP's policy committee on May 24, 2002.
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SEXUALLY TRANSMITTED DISEASES/INFECTIONS
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
Sexually transmitted disease/infection (STD/STI) prevention education, screening, and treatment services should be incorporated into medical care wherever appropriate. This includes not only family planning clinics, where many do provide STD/STI prevention services, but also primary care clinics.
All health care providers should be trained to diagnose, treat, and promote prevention of STD/STI. Services should be provided with cultural competency appropriate to the particular individual being served.
Research on prevention, cures, and treatment, including vaccines, for STD/STIs should be a priority for government and private industry. Because women are disproportionately affected by STD/STIs and their consequences, an emphasis should be placed on female-controlled methods.
Public education programs that use a combination of approaches to prevent STD/STIs transmission are essential.
- Promoting abstinence is a useful and important way to prevent the transmission of STD/STIs; promoting abstinence at the expense of education about effective condom use can only increase the incidence of STD/STIs. Educational programs should highlight the fact that the consistent and correct use of condoms during sexual activity is very effective in preventing the spread of STD/STIs. [1]
- Comprehensive school-based STD/STIs education that is appropriate to students' age and developmental level is an essential part of education programs. Effective programs respect the diversity of values and beliefs represented in the community and complement and augment the STD/STIs education children receive from their families.
- Effective school-based STD/STIs education curricula provide comprehensive, medically accurate information on sexual and reproductive behavior and health. ARHP supports abstinence education as a component of an overall STD/STIs prevention strategy, and recommends that abstinence be taught in the context of a comprehensive program of sexuality education so that individuals have all the information they need to make safe and informed choices about their sexual behavior.
- Within public education programs, particular emphasis should be placed on special populations most at risk for STD/STIs in the United States and abroad.
Health care providers should consider routine and confidential testing for STD/STIs for patients at high risk. Testing for STD/STIs is a matter between patients and health care providers and justification for these tests to government agencies is an invasion of privacy.
All individuals, regardless of insurance status or coverage, should have full and equal access to available HIV/AIDS treatments.
Reference
- Warner DL. Male condoms. In: Hatcher RA, Trussell J, Stewart F, et al (eds): Contraceptive Technology, Seventeenth Revised Edition. New York: Ardent Media, 1998, pp. 325-355.
ARHP's Sexually Transmitted Diseases/Infections statement was approved by ARHP's board of directors on September 12, 2003.
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VIOLENCE AGAINST WOMEN
[This statement is currently under review by ARHP’s policy committee. An updated statement will be posted as soon as it is revised and approved by the ARHP board of directors.]
Physical, sexual, and psychological violence against women, as well as intimidation and coercion, are problems that adversely affect the health and well-being of millions of women and their families. In addition to intimate partner and family violence and military uses of violence against women in war, this issue also includes forced prostitution, forced pregnancy, forced sterilization, forced abortion, female infanticide, marital rape, female genital mutilation, and other traditional practices harmful to women. Violence against women can affect women of all ages, sexual orientations, socioeconomic backgrounds, racial and ethnic groups, and religions.[1]
The fear of violence is a significant constraint on the mobility of women and limits their access to resources and basic activities. High social, health, personal, and economic costs to the individual and society are associated with violence against women.
Health care providers play a critical role in mitigating the effects of violence in women's lives. Many women disclose violence in their lives to their health care providers, either directly as part of health history or indirectly by virtue of symptoms. Knowledge and clinical skills about violence against women, including culturally appropriate, compassionate communication skills, should be included in education and training curricula for all health care professions. Appropriate assessment, intervention, and referrals should be an integral part of clinical care for all women. Because abuse often begins or escalates during pregnancy,[2,3] assessment during pregnancy is essential.
ARHP supports public policies that promote information and education about the nature, extent, and consequences of violence against women and advocate and teach non-violence. Educational systems for all age groups should promote self-respect, mutual respect, non-violent conflict resolution, and cooperation between all individuals.
References
- Helton AS, McFarlane J, Anderson ET. Battered and pregnant: a prevalence study. Am J Public Health 1987;77:1337-9.
- McFarlane J, Parker B, Soeken K, Bullock L. Assessing for abuse during pregnancy. Severity and frequency of injuries and associated entry into prenatal care. JAMA 1992;267:3176-8.
- Helton AS, McFarlane J, Anderson ET. Battered and pregnant: a prevalence study. Am J Public Health 1987;77:1337-9.
ARHP's position statement on Violence Against Women was recommended by the ARHP policy committee in May of 2005 and approved by the ARHP board of directors on June 4, 2005.
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