Position Statements

Access to Reproductive Health Care Contraception/Emergency Contraception Environmentalism Funding for Continuing Professional Education Improving Patient Care through Collaborative Practice Rape, Sexual Assault, and Intimate Partner Violence Reproductive Health and the Environment Reproductive Health within Clinical …

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:

Access to Reproductive Health Care

All individuals have the right to safe, effective, affordable, and accessible reproductive health care, and contraceptive counseling, regardless of age, race, ethnicity, income, sexual orientation, or immigration status. Disparities in access to health care are a major public health failure and lack of access leaves many individuals without adequate health care services.

ARHP supports the availability of all safe and effective reproductive options, and supports health care reform efforts and legislation to provide individuals with access to affordable, quality reproductive health care. The passage of the Patient Protection and Affordable Care Act has the potential to have a strong positive impact on access to reproductive health services. ARHP supports public funding for reproductive health counseling and services through Medicaid, Title X, and other programs, and encourages state and federal policy makers to prioritize resources in order to build on current funding levels.

ARHP opposes laws restricting coverage of reproductive health services for public employees, including women in the military and female dependents of men in the military.

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 reproductive health care equates to discrimination against the poor.

Private insurers should reimburse the cost of reproductive health services, including abortion, 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 reproductive health care, including contraception and abortion services.

ARHP opposes restrictions on reproductive health services/benefits imposed by faith-based hospitals and institutions.

While an individual health care providers’ religious or moral beliefs should be respected, those beliefs must not limit the scope or the quality of health care available to patients. Statutory “conscience clauses” and “refusal clauses” pertaining to health care providers, including pharmacists, must not be allowed to deny or impair the access to legal reproductive health services, procedures, and medications. Health care providers who do not provide abortion services on moral or religious grounds have a professional ethical obligation to refer in a timely manner to another health professional known to provide such services. A woman with an unintended pregnancy has the right to be fully informed in a balanced and accurate manner about all of her options, including abortion, carrying a pregnancy to term, and becoming a parent, or carrying a pregnancy to term and making an adoption plan. Health professionals should not coerce their patients and should make every effort to avoid introducing personal bias while counseling women with an unintended pregnancy.

Confidential reproductive health care for adolescents is essential and should be protected by law to ensure the best possible health care and good reproductive health outcomes for young people. ARHP opposes state parental consent and/or notification laws for reproductive health services for minors, since such laws prevent access to care and contribute to unintended pregnancy. Effective parental-teen communication around reproductive health issues may be ideal, but not every young person has a trusted parent, guardian, or adult to whom to turn  and parental consent and/or notification laws do not help in achieving this ideal.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Contraception/Emergency Contraception

Contraception is an essential and basic preventive health service. In the United States, almost half of all pregnancies are unintended; contraceptive use is key to reducing the number of unintended pregnancies and the need for abortion.

Because of their unique reproductive capacities, women most often bear the burdens stemming from inadequate access to contraception. Access to contraception directly affects a woman’s 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.

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 individuals plan their families. In order to realize the potential of 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 (EC)—a group of safe, effective methods that women can use to prevent unintended pregnancy after contraceptive failure or unprotected/unwanted sex—has the potential to substantially reduce unintended pregnancy. Emergency contraception is not the same as medical abortion.

Because emergency contraceptive pills meet the US Food and Drug Administration’s standards for making a drug available without a prescription, and because several types of emergency contraceptive pills are most effective the sooner they are taken after unprotected sexual intercourse, ARHP supports the distribution of EC pills over-the-counter without delay or discrimination based on age. Requiring proof of age/identification to obtain emergency contraceptive pills creates barriers for immigrant women, in particular, since many do not have government-issued identification. Imposing an age restriction on access to emergency contraceptive pills puts adolescents at increased and unnecessary risk for unintended pregnancy.

Many women have reported being refused access to emergency contraception or being unable to find an open pharmacy that stocks these products. It is the professional responsibility of any health care professional who refuses to provide emergency contraception services to provide a timely referral to these services.

ARHP 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 of care and evidence based medical practice/policy.

ARHP strongly encourages all health care providers to discuss EC with patients of all ages so they will have the information they need to prevent pregnancy after unprotected or unwanted intercourse. Primary care providers should integrate discussions of contraception and EC into patient encounters to reduce risk of unintended pregnancies.

ARHP supports funding for and accessibility of the Copper-T intrauterine device for emergency contraception to offer a highly effective emergency contraceptive to women who also seek long-acting reversible contraception since use of the Copper-T IUD as emergency contraception has been shown to decrease unintended pregnancy rates in studies where such efficacy has not been demonstrated with hormonal emergency contraception methods.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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ARHP supports environmentalism efforts and strives to meet its core mission of assuring reproductive health as it related to preservation of the natural environment. ARHP’s physical office space, business practices, and educational activities should promote healthy living and resource conservation.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Funding for Continuing Professional Education

Patients receive the best quality reproductive health care from professionals who receive continuing professional education on the most current, evidence-based research findings, and ARHP supports federal, foundation, industry, and other appropriate funding for continuing professional education.

Federal funding has not typically been provided to accredited organizations for continuing professional education in the health professions. Such funding has the potential to improve the public health and promote the Healthy People 2020 goals.

Funding from industry for continuing professional education is important, and educational activities that are funded by industry can be very effective when appropriate measures are taken to prevent undue influence from industry.

Accrediting bodies, such as the Accreditation Council for Continuing Medical Education, play an important role in ensuring that funding provided for continuing professional education result in activities that are independent, free of commercial bias, and based on valid content.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Improving Patient Care through Collaborative Practice

ARHP supports the provision of reproductive health care services by all qualified health providers. A multidisciplinary approach to health care can be cost-effective and can increase the availability of needed health services.

Quality of patient care is enhanced when a team of health care providers works together with mutual respect, trust, and integrity to create a practice that draws upon the strengths of a variety of professional groups and specialties.

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.

ARHP supports prescriptive authority and equitable reimbursement for all appropriately trained and qualified health care providers including nurse midwives, nurse practitioners, physicians, physician assistants, and pharmacists, within their practice specialty.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Rape, Sexual Assault, and Intimate Partner Violence

Physical, sexual, and psychological violence, as well as intimidation and reproductive and sexual coercion, are problems that adversely affect the health and well-being of millions of individuals 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 unwanted pregnancy that ends in delivery, forced sterilization, forced abortion, female infanticide, marital rape, female genital mutilation, and other traditional practices harmful to women. The fear of violence is a significant constraint on the mobility of women and limits their access to resources and basic life activities.

Health care professionals play a critical role in mitigating the effects of violence. Many patients 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 of violence-related signs and symptoms, including culturally appropriate, compassionate communication skills, should be included in education and training curricula for health care professionals. Appropriate assessment, intervention, and referrals should be an integral part of clinical care. Because abuse often begins or escalates during pregnancy, assessment during pregnancy is essential.

ARHP supports public policies that promote information and education about the nature, extent, and consequences of violence 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.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Reproductive Health and the Environment

Scientific evidence has shown that environmental factors can contribute to significant negative reproductive health outcomes, and there is a need for additional scientific research on this linkage, including the mechanisms, levels, and types of environmental exposures that can adversely affect health.

ARHP supports the “precautionary principle” to guide environmental policies and protect public health. Given the evidence of significant harm from environmental toxicants on reproductive health, policy makers should take appropriate preventive or corrective action to reduce/eliminate the risk of harm to individuals prior to scientific consensus on this issue.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Reproductive Health within Clinical Training Programs

Health care providers play a critical role in making contraception available by educating 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, or pharmacist who encounters women and/or teens at any entry point in the health care system should have access to and pursue medical education on providing comprehensive, unbiased, and culturally competent contraceptive services.

The current shortage of abortion providers in the US has an adverse impact on women’s health, and ARHP supports efforts to increase the number of health professionals trained to provide abortion services. Abortion education and training should be available to all appropriate health professions students, with exceptions only to meet the needs of individuals whose personal beliefs preclude them from providing abortion services.

Perpetuating misinformation about abortion as a strategy to reduce the abortion rate is a public health problem that puts women at risk. Because of the overabundance of misinformation about abortion, health care professionals should ensure that evidence-based information and practices are being utilized.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Reproductive Rights

Society benefits when individuals have the power and resources to make healthy decisions about their bodies, sexuality, and reproduction for themselves. Individuals should have full control and decision-making authority over their own bodies, without governmental controls, without coercion, without violence, without discrimination, and without regulations that limit or delay access to care.

Coercive reproductive health actions, such as forced sterilization and forced contraceptive programs, are harmful to individuals and to society.

Abortion care is a critical component of comprehensive reproductive health care, and ARHP supports a woman’s right to choose to have an abortion. 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.

The intervention of legislative bodies into medical decision-making is inappropriate, unethical, and dangerous. This includes legislation to prohibit “partial birth abortion” (which does not delineate a specific procedure recognized in the medical literature), legislation to mandate parental involvement for adolescents seeking abortion services, legislation requiring mandatory waiting periods for abortion, government-scripted counseling messages to individuals seeking abortion services, government-required ultrasound procedures or actions related to how an ultrasound is performed, and the “global gag rule” regulation. Scripted messages violate ethics of the health care provider of providing informed consent.

Legislation that grants constitutional rights or protections and “personhood” status to fertilized reproductive tissues is a violation of the separation of church and state and would have significant negative effects on a number of safe, legal medical treatments.

ARHP opposes shackling incarcerated pregnant women, which can pose a danger to women’s and fetal health.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Screening and Prevention of Reproductive Cancers and Breast Cancer

ARHP supports successful, evidence-based strategies that reduce the incidence, morbidity, and mortality of reproductive cancers and breast cancer.

Federal funding for high quality research and evidence-based public information campaigns about the risk factors of reproductive cancers and breast cancer should be 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.

Because HPV infection has been shown to be a cause of cervical precancerous changes and cancer, appropriate and early use of the HPV vaccine has the potential to significantly reduce the incidence of cervical cancer and improve public health. Cervical cancer vaccines should not be withheld from girls and adolescents for fear that providing the vaccine will promote sexual promiscuity.

Genetic testing for reproductive cancers and breast cancer has potentially advantageous as well as potentially harmful effects. Individual patients, in consultation with their health care providers, should be able to decide whether or not to undergo genetic testing.

The highest quality studies and expert consensus show there is no causal link between induced and spontaneous abortion and risk for breast cancer, and ARHP supports efforts that inform individuals about this evidence.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Sexuality, Sex Education, and Sexual Rights

Sexual expression is a normal and healthy part of human behavior. Individuals have the right to live in accordance with their sexual orientation whether they are bisexual, heterosexual, gay, or lesbian. The legal system should guarantee the civil rights and protection of all people, regardless of sexual orientation. It is unethical for health professionals to discriminate against patients based on sexual orientation.

Effective sexuality education encompasses sexual development, reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles. Health care professionals, parents, guardians, and educators have a role in providing comprehensive, accurate, age-appropriate information about sex and sexuality. Health care providers should be able to communicate information about sex and sexuality without restriction to patients in private, including the provision of sexuality information to minors without parental consent or notification. Comprehensive school-based sex education that is appropriate to students’ age and developmental level should be an essential part of curriculum and should provide comprehensive, medically accurate information on sexual and reproductive health. Abstinence education should be taught only in the context of a comprehensive program of sexuality education, and all individuals should be informed and empowered to make informed choices about their individual sexual behavior. Educational programs should highlight the fact that abstinence is not an option for many populations at risk for HIV/AIDS, and other sexually transmitted infections, as women with limited power are not always able to delay initiation of sex or limit their number of sexual partners.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Sexually Transmitted Infections and HIV/AIDS

Health care providers should consider routine and confidential testing for STIs for patients at high risk. Testing for STIs is a matter between patients and health care providers, and justification for these tests to government agencies is an invasion of privacy.

Research on prevention, cures, and treatment, including vaccines, for STIs should be a priority for government and private industry. Because women are disproportionately affected by STIs and their consequences, an emphasis should be placed on female-controlled methods.

Promoting abstinence is a useful and important way to prevent the transmission of STIs, including HIV/AIDS; promoting abstinence at the expense of education about effective condom use will only increase the incidence of 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 STIs.

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.

Needle exchange programs can be an effective tool for decreasing the transmission of HIV/AIDS.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

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Stem Cell Research/Cloning

ARHP supports responsible, high-quality, ethical research involving human embryonic stem cells and human non-embryonic stem cells, which has the potential to lead to better treatments and cures for many disabling conditions. Individual health care professionals’ religious or moral beliefs should be respected, and no one should be required to participate in stem cell research if he or she finds it objectionable. Because of scientific uncertainties and ethical concerns, ARHP does not support reproductive somatic cell nuclear transfer (SCNT) for reproductive purposes.

Recommended by ARHP’s policy committee June 2012, and approved by ARHP’s board of directors June 30, 2012.

Drug Integrity Associate Audrey Amos is a pharmacist with experience in health communication and has a passion for making health information accessible. She received her Doctor of Pharmacy degree from Butler University. As a Drug Integrity Associate, she audits drug content, addresses drug-related queries

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