Category Archives: Reproductive Health Care

Weighing the Benefits (and Risks) of Birth Control

A study published last week in the New England Journal of Medicine (NEJM) found a slightly elevated breast cancer risk among women who used low-dose hormonal birth control.

The roughly 20 percent increased risk of breast cancer—similar to the extra breast cancer risk contributed by physical inactivity, excessive weight gain in adulthood, or drinking an average of one or more alcoholic drinks per day—was found to be the same no matter what method of hormonal birth control was used.

When we spoke to Maine Family Planning medical experts, they said women and teens contemplating hormonal birth control (like the Pill, or long-acting reversible contraceptives/LARCs) should not be alarmed by the new research.

For one thing, this was an observational study and therefore it does not prove conclusively that hormonal contraception is definitely the cause of the increased risk—only that it may be a factor, just like female gender or advancing age.

As Aaron Carroll, professor of pediatrics at Indiana University School of Medicine, further explained in Sunday’s New York Times: “This was a prospective cohort study, meaning it was an observational study that followed women over time and saw what happened to them naturally. The data set didn’t allow for adjusting for some factors that could also be associated with breast cancer, like age at first menstruation; whether women breast-fed; whether they consumed alcohol and how much; whether they were physically active; and more. The study found only an association, and not causal proof you might obtain from a randomized controlled trial.”

For another, the increased risk documented by the researchers is still quite small, amounting to one additional case of breast cancer in every 1,500 women. And young women bear even less of the impact.

“The absolute increase in risk [found in the study] is 13 per 100,000 women overall, but only 2 per 100,000 women younger than 35 years of age,” wrote epidemiologist David Hunter, of the University of Oxford, in an editorial accompanying the study in NEJM.

Meanwhile, hormonal contraception continues to carry well documented benefits, including its efficacy in preventing unwanted pregnancy (which carries its own significant health issues), and substantial reductions in ovarian, endometrial, and colorectal cancers later in life. The New York Times spoke with a number of doctors who cautioned against reading too much into the research findings:

While the new study’s findings about breast cancer are important, “these results are not a cause for alarm,” said Dr. JoAnn E. Manson, a professor of women’s health at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital.

“It’s really problematic to look at one outcome in isolation. Hormonal contraception has a complex matrix of benefits and risks, and you need to look at the overall pattern.”

“When it comes to making your own personal health choices, you need to consider the entire set of benefits and risks,” said Kohar Der Simonian, MD, Medical Services Director for Maine Family Planning. “If you have concerns, the best thing to do is to bring them to your doctor or health care provider and find the solution that’s the right fit for you, as an individual.”

Here’s more from Bedsider.

For Maine Women & Families, Susan Collins Must Vote NO on Disastrous Tax Bill

Red alert! Senator Susan Collins is caving and she needs to hear from YOU—today and every day until the Senate votes on the morally vacant tax bill.

There are myriad ways this cruel legislation would hurt low-income and middle-class folks—all in the name of giving tax breaks to corporations and the wealthy—but we are particularly concerned by how the proposal could impact women and families. Not only does the bill cut key deductions that help Mainers make ends meet, but it tries to sneak in major policy changes that have nothing to do with “tax reform,” like gutting Obamacare and inserting anti-abortion language into an obscure provision on college savings. Bottom line: The tax bill is an abomination and it must be defeated.

From eliminating the student loan interest deduction and certain childcare credits to raising taxes on families that have serious and costly medical conditions, the “Tax Cuts and Jobs Act” includes many provisions that will make it harder for lower-income women and families to get by. Multiple analyses have shown that the tax plan’s biggest beneficiaries will be Wall Street titans and the super-rich, while middle- and lower-income households will see few, if any, benefits.

And then there’s the stealth attempt to repeal the Affordable Care Act’s (ACA) individual mandate through the tax bill. Putting aside that the some members of Congress just can’t seem to accept the fact that the American public doesn’t want Obamacare to go away, this is a dangerous proposal that would result in an estimated 13 million people losing their health coverage.

According to the Maine Center for Economic Policy, without the individual mandate, Mainers could see their premiums go up by as much as $3,000 in Maine’s more economically-depressed regions and the state’s uninsured rate would go up from 6.8 percent to 11.8 percent within 10 years.

When folks lose their health insurance, it puts more pressure on organizations like ours—Title X-funded health care providers who serve low-income, uninsured patients every day. When you consider that the Trump administration is simultaneously waging war against birth control affordability and family planning providers (not to mention the “anti-abortion Easter egg” tucked into the tax bill), you have a perfect storm with women’s health and autonomy in its eye.

Call Senator Collins TODAY and urge her to vote NO on the obscene tax bill. Urge her instead to support proposals that improve the health and well-being of Maine women and families. Together, we can make our voices heard.

Call (202) 224-2523 now.

Or call one of her state offices (you can call any office, not just one near you):
Augusta – (207) 622-8414
Bangor – (207) 945-0417
Biddeford – (207) 283-1101
Caribou – (207) 493-7873
Lewiston – (207) 784-6969
Portland – (207) 780-3575

After Cyber Monday Comes #GivingTuesday

Reproductive Justice Champions support a wide range of Maine Family Planning services and programs.

Tomorrow, November 28, is Giving Tuesday, a global day of giving that offers folks the opportunity to support their favorite charities amidst holiday shopping and deal-scoring bonanzas.

We hope you’ll participate in this altruistic activity by donating to Maine Family Planning. In particular, we urge you to consider our Reproductive Justice Champion monthly giving program. By committing to a monthly donation, you help us provide comprehensive reproductive health care to women, men, and teens across Maine. You help us empower teens to make healthy decisions through our Best Practices sexuality education curriculum. You help us advocate for your rights in Augusta, in Washington, D.C., and in courtrooms. You help transgender Mainers, rural Mainers, low-income Mainers… You get the picture.

And we need your support now more than ever. With a hostile administration in Washington, D.C., family planning providers like us have a target on our backs. From affordable birth control to abortion access, the Trump administration is waging a multi-pronged attack on women’s health care. Loyal friends like like you help us fight back.

Donate here.

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 Contraceptive Method is Best for Me? Part 3 – LARCs

So far in this blog series, we have focused on the two most common forms of birth control options used by teens; condoms and the birth control pill. For this post, we will be discussing LARCs. Of course, there are plenty of other birth control options, such as the Depo-Provera™ shot, the hormonal patch and NuvaRing®. These are also great options, but are much less popular than the condom, pill, and LARCs.

LARC is an acronym for long-acting reversible contraceptives. This means you get these types of birth control inserted into your body and basically don’t have to think about it again for anywhere between 3 and 12 years. Two great examples of long-acting reversible contraceptive options are the implant and the intrauterine device (IUD).

As with any birth control method, there are horror stories that scare teens away from taking the plunge and getting a LARC.  LARCs do seem like kind of a big deal, because you actually have to go to your doctor and have them inserted, but they are very safe and very effective. I, personally, have had both the implant and the IUD, and I can assure you, the insertion for each is not scary in the slightest bit.

For starters, let’s focus on the implant. The implant (Nexplanon®) is a little plastic bar that is inserted under the skin of your arm (around your bicep area) by your doctor. It contains the hormone progestin that works in two ways to prevent pregnancy; this hormone thickens your cervical mucus to keep sperm from reaching an egg, and it also works to prevent your ovaries from releasing an egg in the first place.

The implant can be a great option for teens because once it’s inserted, you never have to worry about it again for up to 4 years! Of course, using a condom as well is important because the implant does not prevent the contraction of STIs. Once the implant is inserted, it is nearly undetectable. You may have a tiny dot scar at the place of insertion, but besides that, nobody would ever know there was an implant in your arm. This is great for teens who don’t want people to know they are on a form of birth control!

The insertion process for the implant is simple! It is almost just like getting a shot. The implant is placed on the inside of your upper arm, and it is inserted through a needle. Before getting mine, my doctor went over the process and showed me the device used to insert the implant. It was nearly pain-free. The worse part of the process was getting a shot in my arm that numbed the area before the insertion! A lot of teens worry about birth control methods like the implant because it requires a doctor’s visit and a “procedure.” However, it is very simple, safe, and pain-free.

The implant can be expensive, but it is covered by most insurance plans! If you are not insured or do not want the implant to go through your parent’s insurance, check with your local Family Planning to see what options they might have for free or low-cost implants! The arm implant is over 99% effective, and it’s a great option for teens because there really isn’t any responsibility to maintaining that effectiveness like there is with the daily oral contraceptive.

The implant can cause some irregular bleeding or spotting for 3-6 months after insertion, but otherwise is very safe and free of any serious side effects. If you want more information about the implant, be sure to contact your local family planning clinic http://www.mainefamilyplanning.org/ or check out Bedsider for all the pros and cons of Nexplanon® here: https://www.bedsider.org/methods/implant#side_effects

The IUD is a bit different than the implant because it is a T-Shaped piece of plastic that is placed in your uterus. All IUDs work similarly by making your uterus too hostile an environment for pregnancy. There are hormonal IUDs that also use hormones to stop conception, and non-hormonal IUDs that prevent pregnancy without the use of hormones. The non-hormonal option is great for people who cannot have hormonal birth control!

There are four types of hormonal IUDs—Mirena®, Skyla®, Liletta®, and Kyleena™.  These hormonal IUDs are effective from anywhere between 3 and 6 years depending on which type is best for you. They vary in size as well, assuring that there is an IUD to fit every woman, regardless if they’ve had children or not.

There is only one type of non-hormonal IUD and it is Paragard®. Paragard® is made of plastic and copper and works for up to 12 years!

An IUD is a great birth control option for teens, because, like the implant, once it is inserted it will protect from an unwanted pregnancy until it is removed. Just like with the implant, it is important to continue to use condoms even after you have an IUD inserted. IUDs are excellent at preventing pregnancy, but they do not prevent STIs.

This can be a scary option for teens, because having an IUD inserted requires a doctor’s visit. You can get an IUD inserted at any point in your cycle, but it is best to do while you are on your period because that is the point during your menstrual cycle that your cervix is the most soft and open. Call your doctor or your local family planning clinic to find out if the IUD is a good option for you!

Like I stated above, I have had both an implant and an IUD. I, too, was terrified to take the plunge and get an IUD because I was worried that it might hurt! So, I want to tell you in detail how the whole insertion process works so you can know what to expect if you think an IUD is a good option for you.

Before getting an IUD, my doctor suggested taking Tylenol about an hour before my appointment. This is good because often there is some cramping after insertion, so the Tylenol makes that cramping a bit more bearable. Personally, I’ve always had pretty painful periods, so that’s the type of painful cramping I was expecting, and that’s just what it turned out to feel like. At the office, you’re asked to take your pants off and sit on the table with a sheet over yourself just like you would for a pap smear. Easy enough!

At my appointment, my doctor came in and explained in detail every little thing about the Mirena® IUD, and told me exactly how the insertion would be done. First, they would go in (using tools just like with a pap smear) and look at my cervix. The worse part of the whole process is a little pinch when they grab onto your cervix to steady it so they can get to your uterus. Honestly, the pinch was uncomfortable, but it wasn’t necessarily painful.

Once they’ve grabbed a hold of your cervix, the hard part is over! They first use a tool to measure your uterus (to make sure it’s the correct size for whatever IUD you have chosen,) and then they insert the IUD. Once it is inserted, they trim the little string attached to the device and you’re done! That little string will curl around your cervix in time. The string is there as a way to check that the IUD is still in the cervix where it belongs, and it comes in handy in 3-6 years when you’ll need to have your IUD removed.

If, after having an IUD inserted, your partner can feel it during sex, call your doctor. The string can be cut shorter if need be so that it can’t be felt during sex. Often if the string is cut too short in the first place, it can’t curl around the cervix and can poke your partner during sex.

You’ll usually have a follow up appointment in a month or so just to check that everything is all set. Often, this is a good time for the doctor to trim the string if your partner is feeling it during sex. After this checkup, your doctor will just check on that little string at your yearly exam.

After insertion of my IUD, I was a bit crampy for the rest of that day, but after that everything felt completely normal and suddenly I didn’t have to worry about taking a birth control pill at the same time every day anymore!

The costs for IUDs vary, but they are covered by most insurances. If you do not have insurance, contact your local family planning clinic to see if you can get an IUD for free or at a reduced cost.

IUDs are over 99% effective, and are the longest lasting form of birth control. This is also a great option because there are both hormonal and non-hormonal options. The Mirena® IUD is a good option for women who have heavy and painful periods, and it often stops women from having their period! As with any type of birth control, IUDs can cause some irregular bleeding in the first few months while your body adjusts, but this is normal. Lots of women stop having a period after the first few months of having an IUD.

If you have any questions, contact your local family planning clinic http://www.mainefamilyplanning.org/directories/24/clinic-locations or check out Bedsider for more detailed information about the pros and cons of IUDs here: https://www.bedsider.org/methods/iud#side_effects

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.

 

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.

Fighting for Medicaid is a Feminist Issue

Did you know that 1 in 5 American women in their reproductive years receive health insurance through the Medicaid program? In fact, Medicaid is a lifeline for nearly half of women in that age group who are below the federal poverty line, and nearly a third of Black women in that group (compared with 16% of white peers). Did you also know that LGBTQ+ people disproportionally experience poverty compared to heterosexual and cisgender people, making them more reliant on Medicaid for health care? Did you know that the Medicaid program covers care expenses for 51% of all births in the United States?

In this political moment, one of the country’s largest health care programs—designed to improve access and quality of life for low income people and those with disabilities—is under attack on both federal and state levels. Last month, the proposed American Health Care Act (AHCA) passed a vote in the House and stands to go up for a vote in the Senate. One of the many dangerous components of the AHCA is its targeting of the Medicaid program, which is an essential health care safety net for low income people, as well as a key facet of our nation’s family planning effort. Medicaid allows coverage for family planning services without copays, or penalties and red tape for choosing one type of contraceptive over another. The AHCA’s proposals to shift to a block grant or per capita cap structure for Medicaid would shift more costs to states, which would end up putting more costs on poor patients as well as their providers.

Unfortunately, Maine is also experiencing more localized attacks on our state Medicaid program, known as MaineCare. Maine is one of 19 states that have yet to expand Medicaid under the Affordable Care Act (ACA or Obamacare), due to Governor LePage’s multiple vetoes of this effort. Now, through a waiver application process, the Maine Department of Health & Human Services (DHHS) is attempting to enact rule changes that would place even more barriers to health care before poor and disabled Mainers, and result in potentially thousands more losing MaineCare coverage. Luckily, Maine’s “state plan amendment” has allowed for Maine Family Planning clinics to extend free reproductive health care services to low-income Mainers who are otherwise not eligible for MaineCare. However, the DHHS proposal to eliminate retroactive coverage would have negative effects on our ability to continue offering this service to people who fall through the cracks of our current health care system.

Opponents of these changes spoke passionately at a public hearing in Portland yesterday. One advocate with Homeless Voices for Justice—Dee Clarke—asked blatantly, “Why are you trying to hurt us?” Several mothers, including Clarke, spoke about raising their children on MaineCare, which allowed them to care for their families in the best way possible while facing the daily challenges of living in poverty. A nurse midwife spoke against the proposed $5,000 asset test as one change that would punish many women seeking prenatal care whose families operate small businesses. As she so poignantly put it, “You can’t sell off your small business or farm to afford prenatal care.”

Both the data and human stories make it clear:  Defending and expanding Medicaid is a feminist issue with major implications for women and LGBTQ+ health. The political attacks on Medicaid are fueled by classist stereotyping and stigmatizing of poor people, and the harm disproportionately falls on poor women. Cutting Medicaid means rolling back access to reproductive health care as well. It means more unplanned pregnancies, less healthy pregnancies, and more sick mothers and babies. Progressive Maine organizations are fighting to expand MaineCare this year, and Maine Family Planning is joining them. We continue to fight every day for the well-being of Maine women, teens, and LGBTQ+ people.

If you’d like to learn more about how to get involved in this effort, contact Community Organizer Cait Vaughan at 207-480-3518 or at cvaughan@mainefamilyplanning.org.