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Australian abortion test-case ruling awaited
THE LANCET
POLICY AND PEOPLE
US health measures added to spending bills
W
ith Congress anxious to adjourn so that members can campaign for the fall elections, the agenda in the closing weeks is limited almost exclusively to work on the 13 annual spending bills needed to keep the government operating. Thus, lawmakers hoping to pursue health-related initiatives would seem to be out of luck. But that has not been the case, as members have merely added their bills as riders to the spending bills. The Senate on Sept 5, for example, voted to add two separate health bills to the spending bill that funds the Departments of Veterans Affairs and Housing and Urban Development. One bill, sponsored by Senator Bill Bradley (Democrat, New Jersey), would require insurers to allow new mothers and newborn babies to stay in the hospital for at least 2 days following vaginal births, and for 4 days following caesarean sections. The other bill, sponsored by Senators Pete Domenici (Republican, New Mexico) and Paul Wellstone (Democrat, Minnesota), would forbid insurance companies from imposing different annual and lifetime spending limits for mental illnesses than they provide physical ailments. The bill is a stripped-down version of the “mental health parity” amendment the Senate adopted in April during consideration of separate health insurance reform legislation. The mental health provisions were ultimately dropped from the final health insurance bill (see Lancet, Aug 10, p398). The House effectively ratified the Senate’s action on Sept 11, voting 392–17 to instruct negotiators on the bill to keep the maternity stay and mental health bills as part of the measure, even though they were not part of the spending bill when it passed the House. The House vote also endorsed a separate provision of the spending bill that would pay government benefits to children with spina bifida born to members of the military exposed to the defoliant Agent Orange during the Vietnam war. While the House vote was technically a non-binding one, it represented such strong support that negotiators are unlikely to contravene the instructions. The bills got another boost when President Clinton also endorsed keeping the unrelated health measures in the spending bill. Julie Rovner
Vol 348 • September 21, 1996
US and UN mark Beijing anniversary
O
n the first anniversary of the Fourth World Conference on Women in Beijing, US Health Secretary Donna Shalala joined UN Secretary General Boutros BoutrosGhali in calling for more substantial action to match last year’s rhetoric. Speaking at UN headquarters in New York, Shalala reminded the assembled dignitaries and women’s rights advocates that what was needed was a “platform for action, not for platitudes or rhetoric”. She also used the opportunity to list some of the Clinton Administration’s accomplishments in the field of women’s health issues. Among the specifics she cited were the creation of a domestic violence hotline that allows victims to call toll free any time of the day from anywhere in the USA. Shalala reaffirmed the Administration’s support for the development of a female microbicide aimed at protecting women from HIV. The Secretary announced that US$100 million would be provided
towards developing this product. On the international political front, while not naming regions, Shalala clearly had Bosnia and Asia on her mind. There was no doubt that her references to “outlawing rape as a weapon of war”, and “stopping those who . . . traffic women and children for prostitution” were aimed at specific targets. For his part, Boutros-Ghali spoke forcefully saying that women and children represent an ever rising proportion of the casualties of civil war and internal strife. The Secretary General also pointed to land mines as one reason why “women have now become the primary victims of war”. The most tangible goal of the ceremony was raised by Boutros-Ghali, who called on the UN to “practice what it preached” by increasing the percentage of women working in United Nations from 35% to 50% by the year 2000. Robert Ivker
Australian abortion test-case ruling awaited
T
he Catholic Church and an abortion advocacy group have been granted “friend of the court” status to argue in Australia’s highest court whether key rulings that allow abortion should be over-ruled. This is the first legal challenge to Australia’s state-based abortion laws inherited from English criminal law. Unlike in the USA, abortion is “unlawful” in all Australian jurisdictions. However, two 25-year-old landmark rulings set the benchmark for permissible abortions, and in two states there are some statutory exceptions. Thus abortion is not unlawful when when a doctor forms a reasonable belief that the operation is necessary to avoid serious danger to a woman’s physical or mental health or that possible financial hardship could contribute to this danger. After over 20 years without a prosecution and an estimated 75 000 abortions each year, these two rulings are now being challenged by the Roman Catholic Church in a case in which no abortion occurred.
A clinic is appealing a New South Wales Court of Appeal ruling granting damages to a woman whose pregnancy was diagnosed too late for a termination. The clinic argues the abortion would have been illegal and therefore they should not be liable. The Church warns that an unsuccessful appeal will place Catholic hospitals in an untenable position— one of obligation to advise women about the option of abortion against its moral objections. Others argue that the only obligation for doctors is accurate and timely pregnancy testing and not family planning. The Abortion Providers Federation of Australasia argues that the case could have serious financial implications for those providing abortions. Pro-choice advocates criticise the Church for interfering in personal medical decisions arguing that the law is settled and reversal would throw the current system into chaos. The matter has been adjourned. Stephen Cordner, Kathy Ettershank
817
POLICY AND PEOPLE
US health measures added to spending bills
W
ith Congress anxious to adjourn so that members can campaign for the fall elections, the agenda in the closing weeks is limited almost exclusively to work on the 13 annual spending bills needed to keep the government operating. Thus, lawmakers hoping to pursue health-related initiatives would seem to be out of luck. But that has not been the case, as members have merely added their bills as riders to the spending bills. The Senate on Sept 5, for example, voted to add two separate health bills to the spending bill that funds the Departments of Veterans Affairs and Housing and Urban Development. One bill, sponsored by Senator Bill Bradley (Democrat, New Jersey), would require insurers to allow new mothers and newborn babies to stay in the hospital for at least 2 days following vaginal births, and for 4 days following caesarean sections. The other bill, sponsored by Senators Pete Domenici (Republican, New Mexico) and Paul Wellstone (Democrat, Minnesota), would forbid insurance companies from imposing different annual and lifetime spending limits for mental illnesses than they provide physical ailments. The bill is a stripped-down version of the “mental health parity” amendment the Senate adopted in April during consideration of separate health insurance reform legislation. The mental health provisions were ultimately dropped from the final health insurance bill (see Lancet, Aug 10, p398). The House effectively ratified the Senate’s action on Sept 11, voting 392–17 to instruct negotiators on the bill to keep the maternity stay and mental health bills as part of the measure, even though they were not part of the spending bill when it passed the House. The House vote also endorsed a separate provision of the spending bill that would pay government benefits to children with spina bifida born to members of the military exposed to the defoliant Agent Orange during the Vietnam war. While the House vote was technically a non-binding one, it represented such strong support that negotiators are unlikely to contravene the instructions. The bills got another boost when President Clinton also endorsed keeping the unrelated health measures in the spending bill. Julie Rovner
Vol 348 • September 21, 1996
US and UN mark Beijing anniversary
O
n the first anniversary of the Fourth World Conference on Women in Beijing, US Health Secretary Donna Shalala joined UN Secretary General Boutros BoutrosGhali in calling for more substantial action to match last year’s rhetoric. Speaking at UN headquarters in New York, Shalala reminded the assembled dignitaries and women’s rights advocates that what was needed was a “platform for action, not for platitudes or rhetoric”. She also used the opportunity to list some of the Clinton Administration’s accomplishments in the field of women’s health issues. Among the specifics she cited were the creation of a domestic violence hotline that allows victims to call toll free any time of the day from anywhere in the USA. Shalala reaffirmed the Administration’s support for the development of a female microbicide aimed at protecting women from HIV. The Secretary announced that US$100 million would be provided
towards developing this product. On the international political front, while not naming regions, Shalala clearly had Bosnia and Asia on her mind. There was no doubt that her references to “outlawing rape as a weapon of war”, and “stopping those who . . . traffic women and children for prostitution” were aimed at specific targets. For his part, Boutros-Ghali spoke forcefully saying that women and children represent an ever rising proportion of the casualties of civil war and internal strife. The Secretary General also pointed to land mines as one reason why “women have now become the primary victims of war”. The most tangible goal of the ceremony was raised by Boutros-Ghali, who called on the UN to “practice what it preached” by increasing the percentage of women working in United Nations from 35% to 50% by the year 2000. Robert Ivker
Australian abortion test-case ruling awaited
T
he Catholic Church and an abortion advocacy group have been granted “friend of the court” status to argue in Australia’s highest court whether key rulings that allow abortion should be over-ruled. This is the first legal challenge to Australia’s state-based abortion laws inherited from English criminal law. Unlike in the USA, abortion is “unlawful” in all Australian jurisdictions. However, two 25-year-old landmark rulings set the benchmark for permissible abortions, and in two states there are some statutory exceptions. Thus abortion is not unlawful when when a doctor forms a reasonable belief that the operation is necessary to avoid serious danger to a woman’s physical or mental health or that possible financial hardship could contribute to this danger. After over 20 years without a prosecution and an estimated 75 000 abortions each year, these two rulings are now being challenged by the Roman Catholic Church in a case in which no abortion occurred.
A clinic is appealing a New South Wales Court of Appeal ruling granting damages to a woman whose pregnancy was diagnosed too late for a termination. The clinic argues the abortion would have been illegal and therefore they should not be liable. The Church warns that an unsuccessful appeal will place Catholic hospitals in an untenable position— one of obligation to advise women about the option of abortion against its moral objections. Others argue that the only obligation for doctors is accurate and timely pregnancy testing and not family planning. The Abortion Providers Federation of Australasia argues that the case could have serious financial implications for those providing abortions. Pro-choice advocates criticise the Church for interfering in personal medical decisions arguing that the law is settled and reversal would throw the current system into chaos. The matter has been adjourned. Stephen Cordner, Kathy Ettershank
817