Category Archives: Health Care

‘We Can’t Be Complacent’: Thoughts on Transgender Day of Remembrance

Trans Day of Remembrance vigilToday is international Transgender Day of Remembrance, a day where we honor those whose lives were lost in acts of anti-transgender violence. According to the Human Rights Campaign, 2017 has already seen at least 25 transgender people fatally shot or killed by other violent means—and the vast majority were transgender people of color. “While the details of these cases differ, it is clear that fatal violence disproportionately affects transgender women of color, and that the intersections of racism, sexism, homophobia and transphobia conspire to deprive them of employment, housing, healthcare and other necessities, barriers that make them vulnerable,” HRC declares.

GLAAD has more about the history of TDOR here; a number of vigils are taking place around Maine. A memorial was also held in Portland on Sunday evening.

Maine Family Planning offers Open Door trans health services to folks at our clinics in Waterville and Lewiston, and statewide through our groundbreaking telemedicine technology. We are thrilled to also be on the cusp of expanding in-clinic services to additional locations in 2018. Soon, clinicians in Belfast, Bangor, and Fort Kent will also be able to offer trans health care on-site. This is an important deepening of our organizational commitment to reproductive justice. As Cazembe Murphy Jackson wrote today at Rewire: “It is so important for trans people to be included in the conversations about reproductive justice. ”

Jackson said:

We must reflect on our struggles and ensure that all of us have the ability to decide if, when, and how to become a parent, on our own terms. I believe this is at the core of reproductive justice: In order for any of us to have a taste of reproductive justice, it must be available to all of us. We must honor trans people as we are, while we are here, in every expression of our gender identity and reproduction. Honoring our resilience is resistance and remembrance.

To mark TDOR, Maine Family Planning nurse practitioners (NPs) Meredith Hunt and Sara Hayes—who manage the Open Door Program in Waterville and Lewiston, respectively—offered these reflections on the transgender health services they offer and their impact in Maine communities.

Meredith Hunt:

I really enjoy providing transhealth services.  It feels good to have such a direct impact on improving people’s lives. I love when I can see the happiness in someone’s face when I say “Yeah, I can help you with that.”  I also love that my patients in the Open Door Program really like coming in.  Many of them have told me that it is the only medical appointment to which they look forward.  I think what we are doing is so important and I see the impact in the community first hand. It is not just young people coming to see us. I have several patients who are over 50 and are so happy to finally have a place to go where they are accepted as who they truly are.

I will be attending the Transgender Day of Remembrance (TDOR) services in Waterville this year.  I have attended the ceremonies in Portland in the past.  When they read all the names of the transgender people who have lost their lives in the past year, I can’t help but get emotional.  It is just so wrong and heartbreaking.  I hope that by providing the services we offer, that we in some way are making the lives of transgender people in Maine better.

Sara Hayes:

I am very proud of our trans program at MFP.  We currently have roughly 100 trans patients who Meredith and I are helping through this process and I absolutely love my trans practice.

Working with trans folk to get their inner and outer selves in balance is incredibly rewarding.  Going through puberty as a teenager is especially rough for trans people and together we go through it again, but this time getting the hormones right. I love hearing about and seeing the physical changes my trans patients go through and their excitement is catching, for sure.

I’m also pretty excited that we are expanding the number of MFP NPs doing trans care. We have patients coming to us all over the state.  Meredith and I can do visits via telehealth at any of our sites but I think it is important that we expand our on-site trans care options as well. Julie in Belfast has been getting up to speed and thanks to a MeHAF grant, we are getting Priscilla from Bangor and Christina from Fort Kent trained as well.  My dream is that before too long, trans care is going to be available at all sites with any of our NPs.

Trans folk, especially trans women, have been the targets of violence and derision for forever.  I have been doing trans care for almost 5 years and I hear from my patients that they are getting more support from their families and friends than trans folk have in the past. But for many, safety and support are not a given. The Transgender Day of Remembrance is not only a tribute to those who have tragically lost their lives because of other people’s hate and intolerance, but it is a reminder to all of us that we can’t be complacent about safety because unfortunately trans people are still and will continue to be targeted. Especially since the current administration in Washington is just adding fuel to sparks of intolerance and ignorance that will ignite into violence, not only against LGBT people. but also against minorities, women, and low-income people.

Waiting for the Title X Shoe to Drop

NFPRHA graphic on Guttmacher

Graphic via National Family Planning & Reproductive Health Association on Twitter.

Any day now, we expect the Trump administration to issue its Title X Funding Opportunity Announcement (FOA)—and to be honest, we’re a little nervous.

After all, the Department of Health and Human Services (HHS) political appointee overseeing the Title X program, Deputy Assistant Secretary for Population Affairs Teresa Manning, has publicly opposed the use of federal funds for family planning and stated that contraception is ineffective. The former anti-abortion lobbyist also opposes emergency contraception. What’s more, a memo leaked last month suggested that advisers to the Trump administration are seeking to slash Title X funding by half—and/or to promote the “fertility awareness” method of birth control in place of other, more effective forms of contraception.

The National Family Planning & Reproductive Health Association, of which we are a member, sees the likelihood of an attack on Title X as “High;” the Guttmacher Institute said in October: “Never in its history has the nation’s family planning safety net been in such jeopardy as it is today.”

You can see why we’re not exactly optimistic.

There are a few ways HHS could go after family planning providers through Title X:

  • By cutting or eliminating Title X funding altogether;
  • By altering the parameters of the grant to include so-called “crisis pregnancy centers” (which use tactics of misinformation and deception to prevent women from accessing abortion care) as eligible entities or “tiering” providers (giving preference to public health departments or primary care providers in order to shut out non-profit organizations like MFP);
  • By putting onerous conditions on Title X recipients—and their patients—such as requiring parental notification and consent for teens seeking contraceptive care, a policy repeatedly rejected by the Maine Legislature;
  • By instituting what’s known as the Domestic Gag Rule, which would bar Title X-funded health care providers from talking about abortion as one of three choices available to pregnant patients who come to us for comprehensive options counseling.

Under any of the above scenarios, the Maine Family Planning network of providers (18 MFP clinics, plus four Planned Parenthood sites, 20 Federally-Qualified Health Centers, and five school-based health centers) would be hamstrung in its ability to provide a full range of contraceptive and reproductive health care services to low-income, uninsured, and underinsured women, men, and teens around the state.

We are staying vigilant as the right wing’s latest attack on women’s health care looms. Stay tuned.

We’re Still Fighting

#ImStillFighting

I’m Still Fighting image via Physicians for Reproductive Health

Today, we celebrate Maine’s historic vote to expand Medicaid (MaineCare). The margin of victory (59 to 41 percent, as of this writing) and geographic distribution of votes (supportive communities stretched from towns bordering Canada all the way to southern Maine) clearly demonstrate that Mainers believe access to health care shouldn’t depend on where you live or how much money you earn. Tuesday’s vote means more low-income folks will benefit from a full range of critical health care services, including family planning and reproductive care, and thus brings us closer to realizing our overlapping goals of reproductive and economic justice.

But we’re still fighting. 

First, we must ensure that our elected officials act on the will of the people. Already, Gov. Paul LePage (R) is snubbing Maine voters, declaring Wednesday that his administration will block the expansion until the program “has been fully funded by the Legislature at the levels [the Department of Health and Human Services] has calculated.”

That’s not right—or legal.

According to Talking Points Memo:

Mainers for Health Care, the organization behind the campaign to expand Medicaid, said despite LePage’s bluster, he can’t stop the expansion train without violating state law.

“Under the state constitution, 45 days after the legislature reconvenes, Medicaid expansion will become the law of the state,” the group’s spokesman David Farmer told TPM. “According to the statute, the Department of Health and Human Services has 90 days after that to submit an implementation plan to the federal government, and the implementation itself will take place in mid-August of 2018.”

As Maine Family Planning community organizer Cait Vaughan reminded supporters in an email today, “we’ll need all of you to show up and make sure state legislators follow through on Medicaid expansion.”

Meanwhile, we must remember that until women can use their Medicaid coverage for all the medical services they need—including abortion—this victory remains incomplete. And so we’ll continue our battle to overturn the state’s ban on Medicaid coverage for abortions.

We’re fighting because the right to an abortion is meaningless if low-income or rural women can’t access one.

It’s appropriate that we participated today in the #ImStillFighting “tweetstorm” organized by Physicians for Reproductive Heath, marking one year since Election Day 2016—a year that has seen a wholesale assault on reproductive rights, the family planning safety net, and women’s health care.

See why other, like-minded organizations are Still Fighting, below:


Yes on Question 2 is a Vote for Women’s Health

Maine Family Planning is part of a statewide coalition working to pass Medicaid expansion on November 7th. Here, our community organizer Cait Vaughan shares a little more about why Yes on 2 is a vote for Maine women.

As the community organizer for Maine Family Planning, I’ve spent the last couple of months talking about little else but Medicaid expansion and the opportunity to vote YES on statewide ballot Question 2 on November 7th. Along with our incredible UMaine Orono intern and MFP volunteers, I have been making phone calls, speaking at events, engaging patients in the clinic waiting room, and (most importantly) knocking on doors to encourage Mainers to vote in favor of expanding this critical program. Back in May, I wrote about Medicaid as a feminist issue and how this joint federal and state-funded program is a crucial aspect of the family planning safety net. With Election Day rapidly approaching, I wanted to focus in a bit more on why we at MFP view expanding Medicaid—known as MaineCare in our state—as a vote in favor of women’s health and autonomy.

MFP serves roughly 21,000 patients each year across our 18 clinics that span 12 of the state’s 16 counties.  Roughly a quarter of our patients receive Medicaid right now, which makes sense, considering that women receiving Medicaid are more likely than those on private insurance to receive gynecological care at a family planning clinic or Federally Qualified Health Center (FQHC) instead of a private physician’s office. Women receiving Medicaid are also significantly more likely than those with private insurance or uninsured women to speak with their providers about important issues like contraceptives, sexual history, HIV, and domestic violence. Another 38% of patients who visit our clinics utilize the sliding scale payment option, largely due to a lack of access to health insurance.  This means that many women rely on us as their sole health care provider, and they are some of the folks who will be most positively impacted by expansion. While our clinicians provide excellent and compassionate care, patients need access to the full range of health care services in order to lead lives of dignity, opportunity, and self-determination. Those qualities truly encapsulate our greater mission as a health care provider and advocate in the feminist tradition of improving women’s lives.

One of our greatest contributions as a provider might be the advances we’ve made—via telehealth services—to improve access to sexual and reproductive health care in Maine’s rural and low-income communities. Voting Yes on 2 would allow us to go even farther. Half of the state’s current MaineCare recipients live in rural areas, and MaineCare provides coverage for many telehealth services (not currently inclusive of abortion care). Expanding Medicaid could complement the steps we’ve already taken to ensure that crucial health care services are available to our patients in rural towns like Fort Kent, Machias, and Rumford. MaineCare expansion can assist patients in overcoming economic barriers to health care that are compounded by geography and a sorely lacking public transportation infrastructure.

As a Title X provider, it’s also important to note that Medicaid has become the most significant public funding source for family planning services in the past decade. Medicaid’s funding for family planning outpaces even federal Title X, which is consistently targeted for cuts and has not been able to keep up with the rising costs of delivering care. We experience firsthand the many ways that access to a quality public health insurance program like Medicaid supports improvements in women’s health, the benefits of which have a ripple effect on our entire statewide community. We hope you’ll join us in voting Yes on 2 on Tuesday, November 7th and take an important step in making women’s health in Maine the way it should be.

If you’d like to volunteer a few hours of your time to support Yes on 2, you can join a special canvass of Friends of Repro Rights jointly led by Maine Family Planning & Planned Parenthood this coming Monday, October 30th in Augusta. Find full details & register here.

Sources/For More Information:

New Abortion Data: A Clarion Call to Family Planning Advocates

On Thursday, the Guttmacher Institute released a new analysis published in the American Journal of Public Health, giving insight into US abortion trends.

The data is fascinating and Maine Family Planning views it as a clarion call to continue and expand the work we’re doing in our clinics, in court, and in our communities.

The report from Guttmacher shows an overall decline in the US abortion rate between 2008-2014. Despite the 25 percent decline, abortion is still a common procedure in this country; one in four American women will have an abortion by age 45. Deep disparities remain among different demographic groups, with abortion increasingly concentrated among poor women and a long history of racism and discrimination contributing to differences in the abortion rate according to race and ethnicity.

These findings underscore the important work Maine Family Planning is doing to increase contraceptive use and abortion access around the state, as well as how much is at stake amid political attacks on reproductive health care nationwide. We see a declining abortion rate as a victory only if it is rooted in advances in comprehensive, affordable reproductive health care and the political and social conditions to support reproductive self-determination for everyone. Unfortunately, at least some of the recent decline can be attributed to politically-motivated & medically unnecessary state-level abortion restrictions that prevent women in many states from accessing care when they need it. Additionally, it’s clear that quality health care services remain financially out of reach for some Americans, rendering them unable to effectively plan pregnancies. As the hostile Trump administration continues its assault on health care, we fear these factors will only become more pronounced.

Our focus remains on empowering women to avoid unintended pregnancies via highly effective contraceptive methods, to be able to access abortion when they need to, and to make decisions based on their own visions of the families they want. Maine Family Planning is battling on many fronts to achieve full access to reproductive freedom: From offering comprehensive prevention programming in schools and long-acting reversible contraception (LARC) in our clinics; to providing innovative abortion care via telemedicine; to fighting in court to expand Medicaid coverage for abortions and overturn Maine’s burdensome law prohibiting nurse practitioners from providing abortion; to working with like-minded groups on the upcoming Yes on 2 vote to make Maine the first state to expand Medicaid by referendum. Guttmacher’s latest statistics prove that our work remains vital and necessary.

What type of contraception is best for me? Part 2 – The Pill

Let’s face it, even though condoms are the most accessible form of contraceptive for teens, they aren’t necessarily the “best” option out there. Condoms have to be used correctly every time you engage in sexual intercourse in order to prevent STIs and unplanned pregnancies. This is why it is highly recommended for people who are sexually active to “double up” on their birth control. This means that you use two forms of contraceptives instead of just one. The most common combination is using both condoms and oral contraceptives, i.e., the pill.

Condoms represent a barrier method of birth control, while the pill is a hormonal method. The pill works by regulating a woman’s menstrual cycle and preventing ovulation. In simpler terms, the pill prevents a woman’s ovary from releasing an egg. Without an egg, conception cannot occur because the sperm has nothing to fertilize. The pill also works by thickening cervical mucus to prevent sperm from entering the uterus in the first place!

If used perfectly, the pill can be up to 99% effective! However, in order to be as effective as possible, the pill needs to be taken every day at approximately the same time of day. This can be difficult, especially in the hectic life of a teen! That is why using a condom as well helps to be sure than no unwanted pregnancies will occur. Condoms are also still important, even if you are on the birth control pill, because the pill does not work to prevent the contraction of STIs.

In order to get started on the pill, you need to make an appointment with your doctor or your local Maine Family Planning clinic and get a prescription for a monthly supply of an oral contraceptive. There are many different kinds of the pill that have different doses of the hormones estrogen and progestin, which work together to prevent ovulation and thicken cervical mucus. You can work with your doctor to select the pill with a combination of hormones that is right for you.

Once you have a prescription for birth control pills, you can even sign up to have them delivered to you each month through the mail so you don’t have to worry about getting to a pharmacy to pick up your prescription on time each month!  Maine Family Planning’s Meds by Mail:  CLICK HERE

If you have questions about cost and insurance, as well as possible side effects, don’t be afraid to contact Maine Family Planning. They can answer any questions you may have about getting a prescription for the birth control pill!

Chynna is attending the University of Maine pursuing graduate work in the field of human development with a focus in human sexuality. She is originally from Maine and enjoys spending her free time taking her dog for walks on campus.

Self-Induced Abortion – Questions & Resources

In light of ongoing legislative attacks and widespread uncertainty about the security of abortion rights and access, conversations and resources addressing self-induced abortion (SIA) are increasing. We at Maine Family Planning want to serve as a resource for pregnant people in Maine who are considering their options with regards to an unplanned pregnancy.

It’s important to note that pregnant people have always found ways to terminate pregnancies—whether with the assistance of healers and caregivers, medication or natural remedies, or in a clinical setting like a doctor’s office or family planning clinic. MFP provides a safe and supportive clinical setting for anyone seeking to exercise their legal right to abortion. We offer both aspiration and medication abortion. We strive to be a trusted community-based resource that respects our patients’ dignity and unique needs, while providing education and counseling, in addition to reproductive health care services. It is our sincere hope and highest goal that all individuals living in the service areas of our 18 clinics who need abortion care will feel comfortable seeking out the compassionate professionals at MFP.

We also acknowledge the reality that barriers to accessing abortion exist across the country, and in Maine. Especially noteworthy are lack of public insurance coverage for abortion care, minimal private insurance coverage for abortion care , transportation, work schedules and child care needs that make scheduling appointments challenging, as well as abortion stigma. Some individuals have experienced trauma at the hands of medical providers, and thus lack trust in such institutions. For others, the antagonism of protestors is an insurmountable barrier. Even when clinics like ours provide excellent, nonjudgmental care—there are many reasons why someone might not be able or comfortable seeking out an abortion in such a setting, including a strong personal desire to control their own experience.

When people discuss SIA, they are often referring to self-administering of the pills mifepristone and misoprostol. Some women are acquiring such pills online and self-inducing at home or another location, often with trusted loved ones and caregivers present. Some women have faced legal persecution for such practices, or for the purchasing of pills—so we want people considering this method to both be aware of resources for accurate information on SIA, as well as the potential legal consequences.

Women face difficult—and sometimes seemingly impossible—choices each day in navigating management of their fertility. We know that desperate individuals can resort to self-harm and violent attempts to end pregnancies that they do not wish to carry. MFP advocates and organizes daily for the rights to bodily autonomy and self-determination for women and anyone who can become pregnant. This often means opposing legislative measures that attempt to unjustly surveil and criminalize pregnant people, and advocating fiercely for safe abortion access. We believe in responding to inquiries and concerns from Maine women with scientific and evidence-based answers. We encourage you to reach out to us, as well as seek accurate and feminist sources of information in doing your own research.

Here are some additional resources on SIA and pregnancy options:

Why is there a need for transgender specific healthcare?

For a lot of transgender people, going to the doctor is a big cause of anxiety. Having to explain pronouns and genitalia to the nurse, getting looks from other people in the waiting room, feeling uncomfortable with having to receive reproductive care—it adds up to make the doctor’s visit a really nerve-wracking experience. Even though it can be intimidating, everyone, including transgender persons, should go and get the healthcare they need.

It’s important for trans people to know that there are places they can go for healthcare and feel safe. Maine Family Planning offers their services to people of all genders. That includes STD testing, birth control methods, breast and pelvic exams, emergency contraception, and more. Maine Family Planning also offers a wide range of transgender health services. Hormone replacement therapy (HRT); self-injection lessons; referrals to mental, behavioral, and specialty providers; and other family planning services are offered to transgender patients.

The comfort of our patients, regardless of gender identity and expression, is important. All care and support is provided without judgment. To learn more about what Maine Family Planning can do for transgender patients or to set up an appointment, visit our website or give us a call!

This is a guest post by Adam, one of Maine Family Planning’s student interns.  Adam is pursuing a degree in creative writing. When he’s not writing for class or for Maine Family Planning’s blog, he’s petting cats.

Destigmatizing abortions:  the word, the act, and our reaction.

When and how did the word “abortion” become as abhorrent as a cuss word?  Even the whispered word can silence a room.  I know.  I’ve done it.  Who do we blame?  The “fake news” the “alternative facts” the “something-else-in-media-today”?!  With all the finger pointing flying around our legislative bodies maybe we need to look inward?  Maybe we need to let the trickle down trickle right to our doorsteps much like the spring rain.

Will making the word more mainstream help us?  Using it more in daily vernacular?  How about a challenge?   Humanize the word.  Think of the women, families behind the word.  Not all reasons for abortions are the same, think more like snowflakes.  All different, but all make snow.  All reasons for abortions are different – financial, life goals, timing, needs, wants, desires – but all make up the collective of abortions.

I am here to help.  At Maine Family Planning we ask women to share their stories.  Here is a handful:

“I love and adore the children I have and it’s my responsibility to make (the) right choices for them, without this service I could not accomplish this.”

“At 40 years old, faced with an unwanted pregnancy I made the choice to abort.  My choice – how lucky I am to have that choice and be taken care of by the most compassionate staff.”

“I am a single mother with two children who is struggling to just get by.  We live at a shelter and have no income.  I have been taking birth control and hadn’t had any problems.  I got pregnant with this child while using my pills.  Due to my situation, I decided that I would not be fair or right to bring this child into this family and to also take what little we have away from my two girls.  I truly feel that this abortion was the right choice for me at this time.”

“I came for my abortion and the protesters didn’t have any impact on me.  I had my procedure done due to medical reasons.  It was my choice and I do not feel guilty at all.”

“Some people say it’s not a choice; it’s a right but when you’re in a spot you need to do what you have to.  Trust us, it’s not easy but this world has its ups and downs.  You don’t know my reason.  I’m sure everyone has one and only God can judge you.”

“I am so thankful for having the right to choose.  Protesters and others don’t take into account the negative cycle of events that often occur when so many children are brought into this world by parents who are not mentally, financially, or emotionally prepared.”

“The thought of someone else making a decision about my body/my pregnancy is a very unsettling feeling.  It’s my body, my life, my choice.  America is the home of the free.  It’s my right to decide what happens with my body.”

Seven.  Seven stories to help you humanize an essential piece of women’s reproductive rights.

Maine Family Planning is committed to preserving all aspects of women’s reproductive rights and we are here for you.

Why we need Title X, Abortion Care & Maine Family Planning:

The Title X Family Funding Program gives federal funds to centers—including Maine Family Planning!—that provide services such as contraception, cancer screenings, STD testing, and much more. Enacted in 1970, it was designed to provide quality family planning care to low-income or uninsured persons who may not be able to afford it on their own. With funding from Title X, they can get the care they need at little to no cost. In 2013, it was estimated that
Title X-funded centers served 4.6 million clients nationwide (Guttmacher Institute 2015).

In 2014, approximately 20,000 Maine women received contraceptive services and supplies from
Title-X funded programs (Frost et al. 2016). Without funding from Title X, it’s likely that these women may not have received the contraceptive care they needed. Using contraceptive methods
such as birth control can have benefits in addition to preventing pregnancy such as regulating periods, preventing menstrual migraines, reducing acne, and relieving symptoms of polycystic ovarian syndrome (PCOS). So don’t let people fool you—there are MANY reasons to start using a contraceptive method beyond pregnancy prevention, and contraception services aren’t the only
services provided by Maine Family Planning and other Title X-funded centers.

Due to the Hyde Amendment (FMI HERE), no federal funds can be used for abortion services.  Maine is also a state where Mainecare coverage does not include abortion care.  Maine Family Planning believes that abortion care is a KEY piece of women’s health.

There are bound to be some people in your life saying they do not support a woman’s right to choose unless she has been sexually assaulted or if she will be harmed bringing a pregnancy to term. Often, people view abortion as a last resort, something that should only be considered when there’s nothing else to do. This creates the feeling of taboo, shedding a negative light on those who receive abortion care. Abortion shouldn’t be considered a last resort; it should simply be viewed as another option.

Everyone should have equal access to abortion care, no matter the reason for seeking abortion care, whether it’s sexual assault, harm to the mother, not wanting a child, not being able to afford another child, or any reason at all. The decision is valid; the choice resides with the person who’s pregnant, period.

Some of those people in your life who don’t support abortion may be participating in 40 Days for Life: a group that pickets at Maine Family Planning’s Augusta office every year. Consider fighting back—against them and the stigma surrounding a woman’s right to choose—by participating in our Pledge-A-Picketer campaign HERE.

Maine Family Planning also provides physical exams, pap smears, breast exams, transgender health care, and immunizations! Title X-funded family planning centers are essential for low-income or uninsured women—and men!—who may not be able to afford these services otherwise. It’s not just abortion and birth control; it’s so, so much more.

This is a guest post by Adam, one of Maine Family Planning’s student interns.  Adam is pursuing a degree in creative writing. When he’s not writing for class or for Maine Family Planning’s blog, he’s petting cats.

Sources:
Contraceptive Needs and Services, 2014 Update, Frost JJ, Frohwirth L and Zolna MR, 2016.
< https://www.guttmacher.org/report/contraceptive-needs-and-services-2014-update >