Food and Drug Administration (FDA) Commissioner Marty Makary announced yesterday that the black box warning labels on hormone replacement therapy (HRT) drugs taken for menopause symptoms will be removed. The labels had warned about the risk of stroke, heart attack, and dementia that some studies have shown. Makary noted that science supports removing the label and that this is a major step in helping address the discomfort and health risks, including osteoporosis, that menopause brings.

Some scientists have questioned the unilateral decision-making, saying that a transparent process should have been used to consider the changes.

The labels were added in 2003 after a large study of HRT in postmenopausal women was halted because of the increased risk of breast cancer and stroke that the women in the study experienced. Researchers have since found that HRT does not carry the same level of risk when started near the time of menopause onset, usually around age 50; many of the women in that early study were started on HRT in their 60s and 70s. However, women with a history of breast cancer still may be advised against using HRT because it does increase that risk.

COVID exposure linked to developmental changes

A study of babies born to mothers who had COVID-19 while pregnant found that they were slightly more likely to receive a neurodevelopmental diagnosis, such as speech delays or autism, in their first three years of life. The link between COVID-19 and a diagnosis was stronger in boys than girls and for babies exposed during the third trimester rather than the first or second. Researchers said the risks were still small.

One of the study authors is investigating how inflammation may affect brain development in utero. Research on the 1918 flu pandemic has shown that babies exposed in utero had slightly lower education and earnings levels, suggesting a similar effect.

The above study was conducted prior to widespread introduction of the COVID-19 vaccine. The good news is that other studies have found no link between COVID-19 vaccines during pregnancy and developmental outcomes in children. The American College of Obstetricians & Gynecologists continues to recommend that people be vaccinated before or during pregnancy to protect themselves and their babies.

Senate votes to end government shutdown

The Senate passed a bill late Monday to end the federal government shutdown. The House is expected to vote on the bill by Wednesday, and the president has said he will sign it. The Democrats did not win an extension of tax credits for Obamacare, which had been their primary demand, though Republicans have said they will vote on that issue later this year. Obamacare enrollment for 2026 is happening now, and prices have risen dramatically.

Infant formula contaminated with botulism

At least 15 infants have become sick from botulism since August after consuming ByHeart baby formula. A total of 84 babies have been treated for botulism in the United States since August, and health officials are now investigating whether more of those cases are linked to the tainted formula.

The company recalled some of its baby formula over the weekend, and you can see the batch numbers here. The company makes a small percentage of the nation’s formula supply, so a shortage is not expected.

Symptoms of botulism, which is caused by a toxin made by the bacteria Clostridium botulinum, include loss of head control, drooping eyelids, and a flat facial expression. An expensive IV medication is the only treatment.

Related

A new study conducted in 2021 and 2022 found that more than 9% of parents fed their infants donor or shared breastmilk. Among all parents surveyed, 6.1% had received breastmilk from a milk bank, and 3.7% of parents said they received milk from friends or family. Milk banks pasteurize their supplies and screen donors, but that donated milk is typically given only to babies born prematurely.

The researchers noted that parents may be reluctant to disclose milk sharing to pediatricians and that pediatricians should take the initiative of talking to parents about ways to reduce the risk of exposing their babies to infectious diseases and harmful drugs.

My take: In the past few years, we’ve had shortages of infant formula and multiple recalls of formula for safety concerns. Plus, formula is expensive. People know that breastmilk is the best option, but our country’s lack of paid parental leave makes it nearly impossible to sustain breastfeeding. This is a fixable problem.

Colorado cutting caregiver pay

The Colorado Sun has a somber story about how the state plans to reduce pay to parents caring for their adult children with severe disabilities. Medicaid pays the caregivers $30,000 to $100,000 per year to provide around-the-clock care to their children; the same care in an institution would cost about $400,000 per year. Some of the parents quoted have been told their children’s needs are too complex for institutional care, and there is a shortage of group homes for people with such intensive needs.

Questions?

If you have ideas for topics you would like to see covered by Woman Child Health, please leave a comment. Thank you for reading!

The 19^th has a story on proposed federal cuts to funding to address domestic violence. In fiscal year 2025, programs to support the Violence Against Women’s Act received $713 million. The president’s budget calls for cutting that amount to $505 million for fiscal year 2026, and the House budget proposes funding of $640 million. These funds are used for education to prevent intimate partner violence, housing for those fleeing violence, sexual assault forensic training, legal protection for survivors, and many other services.

In addition, the Centers for Disease Control and Prevention has a Division of Violence Prevention that monitors violence-related injuries and deaths, researches solutions to violence, and partners with state and local agencies to put in place violence-prevention programs. Most of the workers in that division were fired in the spring, and the president has proposed eliminating the division and moving its work under the Administration for a Healthy America, which is not a functional agency.

The article notes that few private philanthropies support programs for domestic violence survivors. Less than 2% of philanthropic giving in the United States goes to causes specific to women and girls. I could list countless statistics about violence against women or tell you how half of women homicide victims are killed by a current or former partner. But I want to point to larger data that show how entrenched male power is in our country.

Where do we stand on equality?

• As of August, 77.7% of women ages 25-54 participated in the labor force compared to 89.8% of men.

• In 2024, women earned 83.6 cents for every $1 earned by a man.

• Women hold 28% of seats in Congress, 18 states have never had a woman governor, and we have never had a woman as president.

This is not to discount intimate partner violence against men, which is less common but also less likely to be reported. Still, most survivors are women, and they are less likely to have the resources to leave a bad situation and must navigate a legal system largely designed by men.

New York judge dismisses abortion lawsuit

Last week, a New York judge dismissed a lawsuit brought by the Texas attorney general that sought to have a New York doctor penalized for sending abortion medication to a patient in Texas. The lawsuit was filed against an Ulster County, N.Y., clerk for failing to impose measures called for by Texas law — a $113,000 fine and a ban on the doctor sending abortion medication to Texas in the future.

The judge said that the lawsuit failed to show a violation of the law or an error of law. New York’s shield law prevents law enforcement and state officials from cooperating with investigations into reproductive and gender-affirming health care as long as the care followed New York law.

Navigating Obamacare enrollment

Enrollment has opened for Obamacare, and while the average amount that insurers charge for a plan is increasing 26% from last year, according to a KFF analysis, the average enrollee will see a 114% increase in their premium unless the enhanced tax credits helping people pay for coverage are renewed. KFF Health News has a piece about shopping for and paying for a plan.

The federal government also offers assisters and agents to help individuals navigate the marketplace. Assisters are trained, certified, and required to provide impartial and accurate information. Agents are also trained and certified but usually are paid by the insurance companies whose plans they represent.

FDA tries to curb use of fluoride supplements

The Food and Drug Administration (FDA) has told four companies that produce fluoride supplements to avoid marketing the products for children younger than age 3 and for older children at low or moderate risk of tooth decay. Some oral health experts considered this a win because they had expected the FDA to ban the supplements altogether.

Recently, Utah and Florida have banned the addition of fluoride to municipal water supplies, so more families are turning to fluoride supplements to prevent cavities in their children’s teeth. The FDA’s own report released last week notes that most of the health concerns related to fluoridation are hypotheses and have weak evidence to support them. The one exception is a condition called fluorosis, which is a staining of the teeth from too much fluoride exposure.

Fluoride supplements come as chewable tablets or lozenges that children must suck on for at least one minute, and the correct dosage varies, which puts the onus on health providers and families to protect children.

Questions?

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While many people read labels when buying food at the grocery store, far fewer of us read the labels of the products we put on the exteriors of our bodies. That’s understandable. Often, the ingredients in our deodorant, shampoo, and make-up are long, unpronounceable words, and we are not sure which ingredients are a threat. Yet, research has shown that some of these ingredients, including phthalates, parabens, and bisphenol A, can harm our health when used long-term.

Lariah Edwards, an associate research scientist at the Columbia University Mailman School of Public Health, studies chemical exposures from personal care products and is the co-lead author of a recently published study in Environmental Justice on how selective shopping for products among Black and Latina women affected their chemical exposures. The study, which tracked the beauty product use of 70 women, is from a community-academic partnership called the Taking Stock study in which researchers partnered with a community organization to engage with women about their beauty products.

Edwards spoke with Women Child Health about why women of color feel pressured to use personal care products, why buying cleaner products is a challenge, and how all of us can reduce our risk of chemical exposures in personal care products. This interview has been edited and condensed.

Woman Child Health: Can you talk about how you became interested in studying this connection between personal care product use in women of color and then their chemical exposures?

Edwards: I am an environmental health scientist by training; I have a background in studying these chemicals that are found in personal care products. We call them endocrine-disrupting chemicals or hormone-altering chemicals because they mess with or disrupt the endocrine system.

These same chemicals that I used to wear gloves and handle carefully in the lab, I noticed they’re in my lotions and in my shampoos, and I think that was probably in 2015 or 2016. During that time, there was a greater recognition around personal care products as a source of exposure for chemicals, but it wasn’t really until I started working with my advisor, Dr. Ami Zota, who, with her colleague Dr. Bhavna Shamasunder, coined this term of “beauty justice,” or the environmental injustice of beauty. This is the idea that, because of these racialized beauty norms that are very much ingrained in our society, where folks of lighter skin and straighter hair are perceived and deemed more worthy of attention, more beautiful, the rest of folks – myself included – are targeted and told that we should use these products to make ourselves look a certain way. And because we use more of these products, we then are exposed to more of these chemicals.

It wasn’t until I started this work that I really got to bring my whole self into my work and think about how the way I identify and the way society perceives me may create certain pressures or feelings to use products that then lead to more chemical exposure, because all of our products have chemicals in them.

These chemicals serve a purpose. The ones we found in our study, like parabens, are preservatives. They make sure your products don’t go bad. So, I’m not necessarily anti-chemical; I just want products that are safe for us.

Woman Child Health: Yeah. Since you’ve touched on this idea of beauty justice, can you talk about how beauty standards and expectations are connecting to these chemical exposures?

Edwards: Yeah, absolutely. We probably all, at some point in time, have felt pressure to look a certain way. I grew up in a small Midwestern town where not many folks were Black, and I started at a young age to realize, oh, my hair doesn’t lay straight. It is curly, and it is big, and it is frizzy. And so, you started to feel those pressures to use certain products – I certainly did.

There are pressures based on what our society has deemed that people should look like. Often, it’s a very narrow idea, a very small view of how someone should look. And when you’re using these products, you’re exposing yourself to all the chemicals that are in them.

We talk about beauty and cosmetics, but this is an everyone problem because men, people of all genders, use lotions, toothpaste, shampoos, conditioners, all of these products, and they all contain multiple chemicals. Our research very much focuses on women because we know they’re heavy users of personal care products, but they’re not the only users, and we should do a better job including others into this thought about who is being exposed to personal care products and who is being pressured to use products to align with a way that society says that we should look.

Woman Child Health: I have found it really interesting in the past few years to see how there’s so much more marketing of products now to men. And I’m like, well, I guess this is moving toward equality, but maybe not in the direction we want to go.

Edwards: Right? My own partner, he’ll now go to the store and buy his own beard products that are being marketed to him, his own shampoos and conditioners, and I always ask, “What’s in that?”

Woman Child Health: All right, in your study, what did you learn about the shopping habits and chemical exposures among women?

Edwards: In this study, we were trying to understand the personal care product shopping behaviors of women in South L.A. – Black and Latina women – and then trying to understand if those shopping behaviors were related to any chemical concentrations in their bodies.

We used surveys to understand what their shopping behaviors were. So, do you consider product ingredients? Do you avoid products with parabens or phthalates? We used a smartphone app to understand what products they were using throughout the course of a week. They were able to take pictures and log their products so we could understand what they were using. How many products are they using? What’s in these products? And then we took urine samples and measured for 28 common personal care product chemicals.

From the survey data, we found that these women are considering their product ingredients as they’re buying them, which is great. We divided up our women into those who said they avoid certain ingredients and those who said they don’t avoid certain ingredients. We found that the ones that said they avoid certain ingredients have lower levels of that chemical in their urine.. So, for example, Black women who said they avoid products with fragrance have lower levels of a very common fragrance chemical in their body. Latina women who avoided products with oxybenzone/BP-3, a common sunscreen ingredient, had lower levels of oxybenzone/BP-3.

We’re seeing that you can effectively shop your way to safety. Although we like that phrase, we don’t always love that phrase because not everybody can afford to shop their way to safety, and you shouldn’t have to. It’s a burden, frankly.

Woman Child Health: Yeah, it is. It takes more time, more money, all of that.

What are some of the barriers to women buying cleaner products that expose them to fewer chemicals? And I realize there isn’t a standard definition of clean.

Edwards: One of the big barriers is access. Oftentimes, products that are nontoxic or organic are more expensive, so if you are working on limited income, you don’t have the means to go out and replace all your products or buy those that often cost more. Then, the advice to shop your way to safety isn’t applicable or helpful.

Also, are the stores that sell those products in your neighborhood? I have a colleague that has done research looking at Boston neighborhoods and saw that areas that are lower income with a higher percentage of people of color often are selling products that are considered more toxic. I live in New York, and when I need a shampoo or conditioner, I recognize that if I just walk up the street, my beauty supply store may not have the greatest variety of clean or nontoxic products.

You can buy things online, certainly, but it is very convenient to be able to walk out of your house and down the street and buy that product immediately when you need it.

Woman Child Health: What is happening on the policy front in terms of regulating some of these chemicals and personal products? I imagine it varies by state.

Edwards: It does vary by state, and we have seen some states have very robust policies around banning certain chemicals from these products, including California and Maryland. Washington State just banned formaldehyde from some personal care products. State by state, we see a lot of what folks feel is needed are outright bans of certain chemicals or classes of chemicals in products, so your phthalates, your PFAS chemicals, formaldehyde. We are hopeful that, on a federal level, we will get there one day with the FDA, but we’re not there yet.

Woman Child Health: The number of chemicals that we’re supposed to be watching for can feel overwhelming. I’m coming from a public health background, and even I don’t know how many different things I’m supposed to be looking for in my products. How can we do a better job of educating women – really, all people – but I’m specifically thinking of women, about the risks of personal care products?

Edwards: Right now, because of where we are on a regulatory standpoint, the burden is on consumers, and that is not how it should be. I’m at an age where many of my friends are parents, and they don’t want to have to think about what they can put on their kids’ hair and bodies. It’s a mental burden that’s exhausting.

The best thing to do is to be informed. Read your product labels and see what’s on them. There are apps like Clearya or Environmental Working Group Skin Deep Cosmetics Database to look up your products, and they will show you what chemicals are in them and whether any of these chemicals are concerning. For example, this chemical is banned in the EU because of concerns about allergens or endocrine disruptions. There are organizations like Toxic-Free Future and Campaign For Safe Cosmetics that are doing this work and have a lot of things online that are easy to read and digest to help you make more informed decisions.

For the folks who think that’s exhausting and don’t want to do all this research before they buy a product, I recommend using fewer products. Maybe you don’t need to use a body spray during the day. Maybe you don’t need to use two conditioners or two lotions. If you use fewer products, you will be exposed to fewer chemicals.

And for folks who run a pretty lean ship when it comes to their personal care product routine, you can get involved in a lot of these organizations. They are advocating for regulations that help keep our products safer. You can let your politicians know that you care about this issue, and they should vote accordingly.

It’s not necessarily about shopping. It’s also about what can you stop using? What can you take away from your routine? And then how can you make your voice heard and let people know that this is an important issue they should be voting on?

Woman Child Health: Yes, and using fewer products saves you some money as well.

Edwards: It certainly does. I also tell folks I’m not perfect. For the products I use on a regular basis, like my hair conditioner, my deodorant, my mascara, I make sure those are very clean because I use them very frequently. But, for example, I rarely wear a full face of foundation, and when I do, it’s not the cleanest foundation because I don’t wear it very often, and that’s just one thing I don’t want to think about. So even the folks in this space, we aren’t perfect, so don’t feel like you have to be because it is exhausting.

Woman Child Health: Yes, and it’s just one facet, right? There’s the whole food conversation.

Edwards: We’ll be here all day.

Woman Child Health: Is there anything else that we haven’t talked about that you would like to touch on?

Edwards: This work is certainly a credit to the on-the-ground team in California because this is a community-academic partnership. The folks at Black Women for Wellness, the community health organizers that are being organized by our partner, LA Grit Media in California, those were the folks who were engaging participants during COVID, when they had to take their entire plan and switch it to virtual or meet people six feet away in front of their houses.

I think when it comes to work like this, community-academic partnerships are the way to go because researchers can only do so much. And frankly, we have blind spots, and people have their rightful concerns about working with academic scientists. Working with community groups really made this a success.

Thank you for talking with us, Dr. Edwards!

Readers, do you have a suggested topic for a future interview? Please leave a message in the comments.

Last year, the Supplemental Nutrition Assistance Program (SNAP) provided food support to more than 41 million people.

Who uses SNAP?

• Children make up 40% of SNAP participants.

• Among children receiving food stamps, 44% live with both parents, 45% live with a single mother, and 5% live with a single father.

• States with the highest percentage of residents receiving SNAP are New Mexico, Louisiana, Oregon, and Oklahoma.

Why is SNAP important?

• Both adults and children experiencing food insecurity are more likely to experience chronic illness. In children, food insecurity is linked to greater likelihood of asthma, anemia, cognitive problems, and depression.

• An analysis found that cutting $1 in SNAP benefits to children results in a loss of $14 to $20 to society in the long term because those children experience worse health, have lower adult earnings, and are more likely to be involved in the criminal legal system.

It’s hard to overstate the importance of people having access to healthy food – and knowing that their access to that will continue.

Related: A cool resource

I found a couple new-to-me public health data resources this week, and I’m going to share those for folks who enjoy digging into data as much as I do. One is the RAPID Survey Project based at the Stanford Center on Early Childhood. The project collects data from families with young children in the areas of material hardship, including food and housing; access to child care; and use of preventive health care.

Florida health officials quiet on vaccines

KFF Health News talked with public health experts in Florida about why the response to the state’s plan to eliminate vaccine mandates has been so muted. The Florida Department of Health is ending vaccine mandates for hepatitis B, chickenpox, meningitis, and pneumonia. The Florida Legislature is expected to consider overturning the law mandating all other vaccines, including measles and polio, early next year.

The scientists interviewed for the story said that the state has instructed both university employees and county-level health officials to remain quiet on the matter, and pediatricians are reluctant to speak up and risk having vaccine-hesitant families leave their practice. The state’s vaccination rate for measles, mumps, and rubella was 89% among kindergartners during the 2024-25 school year, well below the 95% rate needed for herd immunity to measles.

Related: A cool resource, part II

The second public health resource I stumbled upon this week is the Wastewater Scan dashboard that has been set up by Stanford and Emory universities. The dashboard maps levels of flu, COVID, measles, and other viruses detected in wastewater at sites across the United States. As we all go through this giant national experiment of reducing vaccine access and mandates, this could be a very useful tool.

Analysis finds declining gun violence

The Trace has a hopeful story about how gun violence is declining in 75% of U.S. cities, including the cities where the Trump administration says that troops need to be deployed. Gun violence spiked early in the COVID pandemic as people lost jobs and schools were closed but has been falling since reaching a high in 2021.

Source: The Trace

Gun violence prevention researchers credit the reduction to an infusion of federal money to schools and local governments, which, among other things, increased access to counseling and social support services. In addition, the Bipartisan Safer Communities Act, passed in 2022, provided $1 billion for community-based violence prevention, mental health courts, and red flag laws to keep firearms away from those deemed a potential risk.

Most of the pandemic-era funding has ended or is coming to an end, and communities are seeking ways to continue to provide the education and counseling that have led to safer neighborhoods.

California puts public money into Planned Parenthood

California Gov. Gavin Newsom said the state will provide $140 million to Planned Parenthood clinics to ensure reproductive health care can continue across the state. The California Legislature will consider further funding measures when it reconvenes in January. The federal budget bill that passed in July banned Planned Parenthood from receiving Medicaid reimbursement for health services, including mammograms, pap smears, and birth control. In California, 80% of Planned Parenthood patients use Medicaid.

Washington, Colorado, and New Mexico also plan to use public money to keep Planned Parenthood clinics open, and New York and Oregon are considering legislation to do the same.

Study finds higher stillbirth rate

A study released Monday found that U.S. stillbirth rates are higher than the figures published by the Centers for Disease Control and Prevention. Stillbirth counts often rely on fetal death records or medical records, which often lack information because they may be submitted before testing on causes of death has been completed. The study showed the stillbirth rate from 2016 to 2022 was 1 per 150 births, while the rate published by the CDC was 1 per 175 births. The study also found that the rate in communities with a higher proportion of Black families was 1 in 95 births. In more than 27% of stillbirths, no pregnancy risk factors were identified prior to the stillbirth.

Questions?

If you have ideas for topics you would like to see covered by Woman Child Health, please leave a comment. Thank you for reading!

On Sunday, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy (CIDRAP), announced at the conference that two organizations would unite to offer an alternative to CDC’s Morbidity and Mortality Weekly Report (MMWR), which has long been the most trusted source of information on new infectious disease outbreaks. The New England Journal of Medicine and CIDRAP will publish health alerts about disease outbreaks and other public health issues on an as-needed basis. The alerts will be free to readers.

MMWR has operated since 1952 and consistently published weekly reports until the Trump administration paused communications early this year. The weekly reports resumed but have been frozen again during the government shutdown.

In related news

A coalition of Democratic governors in 15 states plus Guam are forming an alliance to coordinate emergency preparedness and public health efforts. Mandy Cohen, who served as CDC director in the Biden administration, will be one of the advisers to the alliance.

Also, 35 of the nation’s largest cities have united to create the Big Cities Health Coalition to promote vaccination in response to the Trump administration’s inaccurate claims about vaccinations.

I am heartened by all these efforts to continue to provide evidence-based information to the public while also concerned about the fracturing of our public health information system. When people have so many sources of information, it becomes difficult for them to glean who they should trust.

ICE criticized over detention of pregnant women

The Associated Press has a story about human rights organizations calling on the Trump administration to stop holding pregnant women in immigration detention facilities. A letter written by the ACLU, Robert F. Kennedy Human Rights (named for the first Robert Kennedy, obviously), and other organizations describes pregnant women being shackled, denied adequate food and water, and denied medical care.

Immigrations and Customs Enforcement says that pregnant women account for only a small number of detainees but refuses to release data on pregnant, postpartum, and nursing people. ICE’s own policy says that it should not detain pregnant, postpartum, and nursing people expect under exceptional circumstances. The policy also calls for regular medical and mental health care in those rare instances.

Head Start programs at risk

Head Start programs that provide preschool to vulnerable children are running out of funding and at risk of closing because of the government shutdown. The programs receive nearly all their funding from the federal government and are not allowed to carry over funds from the previous year. Nearly 65,000 spaces for children could be affected.

Head Start serves children who are from low-income families, in the foster care system, or homeless, and pregnant women and infants are provided with social enrichment through the Early Head Start program. In addition to educational and social engagement, Head Start provides breakfast, lunch, and snacks to children.

Food allergies declining

You’ve slogged through a lot of bad news, so here is a bit of good: A study published earlier this week shows that rates of food allergies among children, especially peanut allergies, have declined greatly since guidance around feeding young children was changed in 2017. Researchers found a 36% decline in food allergies, with a 43% drop in peanut allergies, when they compared data from 2017 to 2020 with earlier data from 2012 to 2015.

In the early 2000s, parents were advised to avoid feeding babies and young children peanuts and other common allergens as researchers struggled to understand what was leading to a surge in food allergies. That guidance started to change around 2015, when a trial found that feeding peanuts to babies greatly reduced the risk of them developing an allergy. In 2017, the National Institute of Allergy and Infectious Diseases changed its guidelines to recommend that common allergens be introduced early to babies. While the study published this week did not track what children ate and therefore cannot prove that a change in eating led to fewer allergies, researchers assume that the new guidelines have influenced baby feeding practices.

Study explains breastfeeding boost to immunity

Biology is amazing! Researchers have determined that breastfeeding causes the body to recruit specialized immune T cells to the breasts, and these cells can stick around for up to 50 years. Researchers have long known that people who breastfeed are less likely to develop breast cancer but didn’t know why.

This study looked at human breast tissue from people who had mastectomies or breast reductions and found that women who had given birth had higher counts of these specialized T cells. The researchers also studied mice with cancer and found that mice who had breastfed had smaller tumors with more T cells at the site than mice who had been forced to wean their pups early.

Now, can we have universal paid family leave so more people can breastfeed?

Questions?

If you have ideas for topics you would like to see covered by Woman Child Health, please leave a comment. Thank you for reading!

Health during childhood greatly influences health in adulthood, which makes programs that improve the health of children very cost-effective. A moderate amount of money spent now can help prevent expensive chronic health problems later. One example of this is the National School Lunch Program, which provides free and reduced-price lunches to 28 million U.S. children from lower-income households, ensuring that they receive fruits, vegetables, and low-fat dairy every school day. Yet, with the passage of the federal budget and tax bill over the summer, some funding for free and reduced-priced school meals is threatened.

In 2014, a policy called the Community Eligibility Provision began providing federal funding for universal free meals to schools with a high proportion of students from low-income households. To reduce paperwork, students whose families qualified for other government assistance, such as the Supplemental Nutrition Assistance Program (SNAP) and Medicaid, were automatically counted toward the school meeting the Community Eligibility Provision threshold for universal free student meals. Once a school met the threshold, all students could receive free meals regardless of income.

The budget bill passed in July created new hurdles to qualify for SNAP and Medicaid, and many families are expected to be cut, causing them to lose their automatic eligibility for free school meals. Fewer qualifying children will lead to fewer schools meeting the Community Eligibility Provision threshold.

Anna Localio, a postdoctoral research fellow in the Department of Health Systems and Population Health at the University of Washington, studies the health effects of free school meals and is the lead author of “School Provision of Universal Free Meals and Blood Pressure Outcomes Among Youths,” which was published last month in JAMA Network Open.

Localio spoke with Woman Child Health about how free and reduced-price meals influence the health of children and their families, how stigma can cause families to miss meals, and how the COVID-19 pandemic moved states to action on school meals. This interview has been edited and condensed.

Woman Child Health: To start, can you talk about why you wanted to study the effects of universal free meals on child health?

Localio: Sure. In the past, I’ve worked on research aimed at changing behavior through individual counseling and education, but I found that, time and time again, it was really the upstream social conditions linked to socio-economic status that created barriers to making healthier choices for individuals and their families. And so, we hypothesized that this policy had the potential to be health promoting because it provides an economic resource, which in this case is nutritious breakfasts and lunches, to millions of students nationwide in schools in high-poverty areas. So rather than encouraging students or families to choose healthier meals, this policy makes the default choice healthy.

Woman Child Health: High blood pressure is something, at least for me, that I usually think of as being an adult health issue. So how common is this among children? Are there certain groups that are more affected?

Localio: Yes, hypertension is very widespread among adults; nearly 50% of adults have it, and another 30% have pre-hypertension. Among children and adolescents, the prevalence of high blood pressure, which includes both hypertension and pre-hypertension, is estimated to be about 11%, but the risk goes up substantially for children with obesity.

High blood pressure is more prevalent in boys than in girls, and like many other chronic conditions, it disproportionately impacts Black and Hispanic children compared to white children, as well as children from low-income families. And while high blood pressure in childhood can cause immediate health impacts, the main concern is that high blood pressure in childhood often tracks into adulthood, and then we know that high blood pressure in adulthood is associated with heart disease and stroke.

Woman Child Health: What did your study find about the health effects of these universal free meals?

Localio: Our study examined children from more than 1,000 schools in several U.S. states. We compared trends in the proportion of children with high blood pressure in schools that participated in universal free school meals to trends in schools that were eligible but had not yet adopted the policy, and we found that the policy was associated with an 11% net decrease in the proportion of children with high blood pressure over a five year period.

Woman Child Health: Normally, if we don’t have universal free meals, students would have a form that comes home from the school, and they have it filled out and then return it. Why is it that children who might qualify for free or reduced-price lunches are not always getting them?

Localio: Yes, so students often report a stigma associated with receiving free meals when they aren’t universally free. Students might be embarrassed to be labeled as lower income than their peers and could even be bullied because of that. There’s also a stigma among parents who have to fill out the application for their child to receive the free or reduced-price meals; parents might be ashamed to list their income on the form or even request the benefit in the first place.

Another point that I think is worth mentioning is that there are a lot of families who are really struggling to make ends meet but might be above the eligibility threshold for reduced-price meals. For the current school year, the eligibility threshold for reduced price meals is an annual income just under $60,000 for a family of four. In an expensive area, for example, Seattle, a family with that income could really benefit from receiving free meals but wouldn’t qualify under the current eligibility criteria.

Woman Child Health: How does receiving the free meals change social dynamics for the kids at school? Do we have information on that?

Localio: Well, based on what we know about the stigma associated with receiving free meals, when meals are universally free, there’s no longer that stigma. Kids are no longer ostracized or seen as different than their peers in that regard.

Another factor is that universal free school meals remove the issue of lunch debt, which is another factor that can cause shame and stigma for children and families, but I think there’s still room for more qualitative research to be done in this area. (Editor’s note: The Education Data Initiative has data on school lunch debt.)

Woman Child Health: Can you talk about how universal free meals affect families? What does this mean for parents and caregivers that are at home?

Localio: Parents report that free school meals do make a difference financially for their families, especially when there are multiple school-age children. Parents no longer have to worry about shopping for breakfast and lunch during the week and packing meals. And there’s evidence that families with kids attending a universal free meals school spend less at the grocery store and buy more nutritious foods. By freeing up disposable income for families, the policy allows families to eat more nutritiously at home as well.

Woman Child Health: That’s really interesting.

You looked at all this data before we went into the COVID pandemic, which is part of the reason I was interested in this. Once we reached early in the COVID pandemic, then at public schools, all the children were able to access free meals, so sort of this large national experiment. Do you know of ways that has changed school policies or state-level policies? Do you expect to see more changes as we get data from that?

Localio: Absolutely, all schools were able to participate in these universal free meals between 2020 and 2022. The following year, California and Maine implemented their own state policies, allowing schools to continue receiving universal free meals, and these states supplement federal funding for these programs with state funds. Then, six more states adopted similar policies, and many other states are considering similar legislation. So, clearly, universal free meals programs are very popular. However, the state programs do still rely on federal funding, so cuts to the Community Eligibility Provision could jeopardize states’ abilities to continue to implement this.

Woman Child Health: Is there anything else that you wanted to touch on or talk about from your research?

Localio: You know, school meals can sometimes have the reputation for being unhealthy, but research shows that they’re actually children’s most nutritious food source, especially for children from lower-income families. The nutritional quality of school meals has also improved quite a bit in recent years, thanks to stricter nutrition standards put into place by the Healthy, Hunger-Free Kids Act.

However, quality, of course, differs by state and by school district, so there’s certainly more work to be done to get more fresh and nutritious foods into schools, and there are great farm-to-school programs all throughout the country that have a lot of potential but obviously require collective investment. I think investing in nutritious school meals is one of the best public health commitments we can make as a country.

Woman Child Health: Yeah, and I feel like it’s one of those issues where it seems like it may be bipartisan, like we might actually be able to bring people together to do this.

Localio: Exactly.

Thank you for talking with us, Dr. Localio!

Readers, do you have a suggested topic for a future interview? Please leave a message in the comments.

The firings at HHS included workers addressing mental health, substance use, and disaster preparedness. Among those fired at CDC were workers addressing violence and injury prevention. All of these issues are worthy of their own article, but I did a quick dive into the data on violence against women.

Why is this important?

• About 41% of U.S. women will experience sexual violence, physical violence, or stalking by an intimate partner during their lifetime. This figure may be an underestimate because intimate partner violence (IPV) often goes unreported.

• Among the many negative health effects of experiencing IPV are reproductive disorders, gastrointestinal disorders, chronic pain, increased risk of substance use disorder, depression, and anxiety.

• More than half of female homicide victims are killed by a current or previous male intimate partner.

• Greater gender inequality within a society is linked to an increased risk of IPV for women and girls, and the Trump administration is working to dismantle employment and health protections for women that reduce inequality.

EPA asked about mifepristone in wastewater

The New York Times has a story (gift link) about an inquiry by the Environmental Protection Agency (EPA) into testing to detect traces of the abortion pill mifepristone in wastewater. Over the summer, scientists were told to study whether they could develop methods to detect mifepristone in wastewater after the EPA administrator received a letter with the request from 25 Republican members of Congress. The EPA scientists later reported that there were no current methods to do this but that such a test could be created. The legislators say that they have not received a response to their letter, and there is no evidence from the EPA is planning to develop this testing, according to the article.

With the COVID-19 pandemic and the overturning of Roe v. Wade in 2022, the number of women using medication to induce abortions has risen dramatically; medication was used for an estimated 642,000 — or 63% — of abortions in the United States in 2023.

Frequently lost in this conversation is that mifepristone is also used to manage miscarriages. An estimated 1,034,000 first- and second-trimester miscarriages occur in the United States each year, and researchers estimate that between 92,000 and 315,000 of these miscarriages are treated with mifepristone. That wide range is a testament to how little research we have on miscarriage. We have seen many reports about how women experiencing miscarriages are being put in danger by abortion restrictions.

South Carolina students in quarantine for measles

With students back in school, measles outbreaks have flared in multiple locations. In South Carolina, more than 150 unvaccinated students are quarantining for 21 days after exposure to measles, and an outbreak on the border of Utah and Arizona is still growing. The U.S. has reported 1,563 confirmed cases of measles this year, the highest number in more than 30 years.

WIC services maintained through October

The United States Department of Health and Human Services is putting forward $300 million to maintain services of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through the end of October. Funding for the program had been in jeopardy because of the government shutdown.

Some funding restored for deaf and blind students

The Education Department has provided funding to the National Center on Deafblindness to provide services to students with both vision and hearing loss for one year. The Trump administration had previously cut this funding, which was supposed to run through September 2028, saying that the programs raised concerns about “divisive concepts” and “fairness.”

The administration will send the funding to the National Center on Deafblindness rather than the four programs that had originally received the grant and were coordinating services. The Education Department objected to other student services run by those four programs, although those services were unrelated to the assistance for deaf and blind students.

California bans ultraprocessed foods in school meals

Last week, California Gov. Gavin Newsom signed legislation that bans ultraprocessed foods from school meals. Because there is no standard definition of ultraprocessed foods, the state developed its own, identifying ultraprocessed foods and beverages as those that contain one or more additives such as thickeners, colorings, and sweeteners, along with high levels of saturated fat, sodium, or added sugar. Schools will have until 2035 to comply fully with the law.

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Among the many programs affected by the shutdown is the Special Supplemental Nutrition Program for Women, Infants, and Children program, more commonly known as WIC, which is expected to run out of federal funding this week or next. Unlike most safety net programs, WIC is not an entitlement, which means those who qualify are not legally guaranteed benefits, and states running short on money can remove WIC recipients from the program.

WIC provided nutrition vouchers to 6.7 million pregnant women, mothers, infants, and children younger than 5 in 2024, including 41% of all infants. The vouchers can be used to buy milk, infant formula, fresh fruits and vegetables, and other staple foods. WIC also funds nutrition education, breastfeeding support, and breast pumps.

What are the effects of WIC?

• Preterm WIC participation is linked to lower risk of preterm delivery and low birth weight.

• Infants receiving WIC are more likely to have well-child visits and receive vaccinations.

• Given the health benefits of WIC, an analysis found that $1 spent on WIC results in savings of $2.48.

Several states have told families that state funding will fill the federal gap, but that is not the case everywhere. Pennsylvania has its own budget crisis and cannot currently move more money into WIC services. Historically, WIC has had bipartisan support, but the spending plan backed by House Republicans would not fully fund the WIC program.

Chicago slow to replace lead pipes

Chicago has received a lot of attention recently about its lead pipes. At its current pace, the city will need until 2076 to replace its 412,000 lead service lines, which is 30 years after the deadline of 2037 set by the Environmental Protection Agency. The EPA has already extended Chicago’s deadline to 2047.

Aging pipes can leach lead into the water supply, especially if the water has high acidity. The EPA banned the use of lead pipes in 1986, but prior to that, Chicago mandated that lead water lines, and the city still has lead water lines serving 2.7 million people. The Biden administration had set aside $15 billion to replace lead pipes nationally through its infrastructure law, but that money must be claimed by next year. The Trump administration’s current budget proposal calls for states to fund their own water infrastructure projects.

Why is this important?

• No amount of lead exposure is safe, and lead is especially dangerous to children, who can experience learning disabilities and developmental delays after exposure. Lead exposure in mothers is associated with low birthweight in infants.

• In adults, lead exposure is linked to cardiovascular problems, high blood pressure, and kidney damage, among other health problems.

• A recent study found 68% of children in Chicago under the age of 6 were exposed to lead in drinking water, with Black and Hispanic children much more likely to have lead exposure but less likely to be tested for it.

A history of blame for autism

The 19^th has an interesting piece on the history of mothers being blamed for their children’s health problems, especially autism. The psychiatrist who first identified autism in 1943 attributed the condition to mothers who were cold toward their children, and a 1960s psychologist who regularly published articles in popular magazines spread this falsehood more widely. The article goes on to discuss the current efforts of the Trump administration to falsely connect autism to parents’ decision to have their children vaccinated and use Tylenol.

We do know that mothers of children with autism are more likely to experience depressive symptoms than mothers of neurotypical children, and, in fact, parents of children with any type of health challenge are more likely to experience depressive symptoms and poor health, with mothers reporting greater stress than fathers. Sadly, all nuance about the causes of autism and how we can best support families is lost in the messages coming from the current administration.

Other news

• KFF Health News has a life-affirming story about how author Barbara Kingsolver has used profits from her novel “Demon Copperhead” to open a recovery center in the Appalachian Mountains of Virginia for women dealing with addiction. If you haven’t read the book, I highly recommend it.

• The Atlantic has an article on the strains faced by pediatricians (gift link) in dealing with vaccine chaos, from longer appointment times because of vaccine hesitancy to having to install more refrigerators to handle single-dose vaccines instead of multi-dose vials.

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We stayed downtown but barely heard road noise because so many people were biking. Couples looked relaxed and happy pedaling out to dinner on a Friday night in their dresses and suits. I couldn’t help but think that this was a better way to live than our car-centric culture.

And yet, Bloomberg has a story about how the Trump administration has cancelled grants across the country for the building of bike lanes, street safety measures, and pedestrian trails, saying that the projects are hostile to motor vehicles. Last year, 7,148 pedestrians were killed by vehicles, which was a decrease from 2022, when the country reached a 40-year high in pedestrian deaths. Most pedestrian deaths occur in locations without a sidewalk, and deaths are increasingly caused by pickups and SUVs rather than cars.

What this means for children

The good news is that the number of children killed by vehicles has been decreasing for decades; the bad news is that this is because children walk much less than they used to. About 11% of U.S. children walk or bike to school, a percentage that has been declining for decades. When researchers reviewed global data on how often children and adolescents participate in active transport such as walking and biking, the United States received a grade of D-.

Walking to school is a positive in almost every way. It increases physical activity among children, builds a sense of independence, reduces air pollution near schools, and creates a sense of community. Parents say that the main barriers to their children walking to school are the distance and the danger from traffic. One of these problems is solvable.

What this means for women

We have limited data on active transit use among women in the United States. Research in other countries has shown that men are more likely to cycle to work than women, and women of higher socioeconomic status who have access to safe infrastructure tend to cycle more than other women. Meanwhile, women with low incomes are more likely to walk — out of necessity — than other groups.

For women, active transit helps protect cardiovascular health and is also linked to reduced anxiety and depression. Needless to say, sitting in traffic has none of these benefits.

Source: The League of American Bicyclists

FDA is reviewing mifepristone

The Food and Drug Administration (FDA) is reviewing the medication mifepristone, which is used for medication abortions and the treatment of miscarriages, according to a letter written by Health and Humans Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Dr. Marty Makary. The percentage of abortions completed using mifepristone at home has increased greatly since the Supreme Court overturned protection of abortion rights in 2022. The American College of Obstetricians & Gynecologists, along with many other medical organizations, has stated that mifepristone is safe and should be readily available to patients.

What you should know

• Medication abortion is very safe in the first 10 weeks of pregnancy, with serious side effects occurring in less than 0.3% of patients.

• Women are much more likely to experience serious complications or death giving birth than having a medication abortion.

• In explaining the review, Kennedy has referenced a study of mifepristone conducted by an organization seeking to spread conservatism and Judeo-Christian values.

As we have seen with vaccine recommendations for COVID, measles, and flu, sound science is no longer the guide for some of the decisions being made.

Abortions in clinics decrease

Abortions provided in clinics decreased about 6% in states without total bans during the first half of 2025, according to new data from the Guttmacher Institute. Florida accounted for a large portion of the decrease as it provided about one-third of abortions in the South prior to implementing a ban on abortions after six weeks in May 2024.

Push to delay hepatitis B vaccine

The Trump administration continues to seek a delay in hepatitis B vaccines for newborns despite the CDC’s vaccine advisory committee tabling the discussion earlier this month. Last week, Trump made false statements about how the disease is transmitted.

The disease is passed through contact with bodily fluids and can be transmitted from mother to baby during childbirth. Providing a hepatitis B vaccine to infants within 24 hours of birth protects them even if they were exposed to the virus. The virus attacks the liver, has no cure, and in the long term, can lead to liver failure and liver cancer if left untreated.

The next meeting of the Advisory Committee on Immunization Practices is set for October 22, and an agenda has not been released.

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As I wrote a few weeks back, none of the studies on Tylenol use during pregnancy show that it causes autism in babies. However, some studies do find a correlation between Tylenol use and autism, which could mean that Tylenol is linked to autism but also could mean that the conditions or illnesses for which people take Tylenol are linked to autism.

Other government leaders have since tried to walk back Trump’s stance. Dr. Mehmet Oz, who leads the Centers for Medicare and Medicaid Services, said that pregnant people should consult with their doctors if they have a fever or pain, and Vice President JD Vance said the same. Sound advice.

Vaccination rates declining in many states

A study published last week found that 26 of 33 states analyzed had significant changes in rates of childhood vaccination against measles, mumps, and rubella (MMR) between 2017-18 and 2023-24. Of these, 22 had declines, while four states, California, Connecticut, Maine, and New York, had increases in MMR vaccination.

Key points

• Three of the four states with increases in MMR vaccination eliminated non-medical exemptions during the time period, and their average vaccination rate increased from 96% to 97.6%. California prohibited non-medical exemptions throughout the period studied.

• States that allowed both philosophical and religious exemptions had the greatest declines, with average vaccination rates falling from 93.8% to 89.5%. The easier it is for parents to choose not to vaccinate their children, the more likely they are to forego vaccines.

• A measles vaccination rate of 92% to 94% is needed to maintain herd immunity and prevent the virus from spreading.

Source: Newsweek

Utah measles outbreak

Meanwhile, a measles outbreak is growing in southern Utah and northern Arizona, where less than 80% of kindergartners are vaccinated against measles. So far, 42 people have been confirmed to have the virus.

STIs declining, except congenital syphilis

A bit of good news: Cases of sexually transmitted infections decreased in 2024, with fewer people testing positive for gonorrhea, chlamydia, and syphilis. Between 2023 and 2024, the number of people diagnosed with syphilis declined 9%, gonorrhea declined nearly 10%, and chlamydia declined 8%.

Unfortunately, cases of congenital syphilis, in which a mom passes the infection to the infant, increased again. Nearly 4,000 infants were infected, a 1.7% increase from 2023. That number has been increasing since 2012. Congenital syphilis can cause deafness, blindness, malformed bones, and even death. A recent study found that only 80% of people are screened for syphilis during pregnancy. Providing syphilis screening to all emergency department patients has been shown to help increase detection among pregnant people.

Study reinforces risks of plastic exposure

Childhood exposure to three types of chemicals used in plastics causes health risks into adulthood, according to a review of hundreds of studies on plastics published this week. Among the increased risks were heart disease, obesity, infertility, and asthma. The chemicals of concern were phthalates, bisphenols, and perfluoroalkyl substances (PFAS), which are found in many items including food packaging, cosmetics, and paper receipts.

Practical ways to reduce exposure are to switch to glass and stainless steel containers, when possible, and to avoid putting plastic in the microwave or dishwasher, which causes the chemicals to leach out.

Members of the United Nations gathered last month to discuss a binding global plastics treaty, which would set limits on production, but failed to reach an agreement. At that meeting, the United States stood against caps on plastic production.

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The Trump administration is pushing for an increase in high-deductible plans, called catastrophic plans, which require people to spend more than $10,000 per year to meet their deductible. Only after the deductible is met does insurance cover health costs. These plans have lower monthly premiums and have historically been limited for purchase to people under age 30. Currently, only 0.2% of ACA enrollees use this type of plan, likely because among U.S. residents, the median total savings in the bank is $8,000.

Why is this important:

• The Centers for Medicare and Medicaid Services estimates that the loss of subsidies will cause between 750,000 and 1.8 million people to lose insurance coverage in 2026.

• Women make up 52% of the 24 million people insured via the ACA. Women have always made up a greater proportion of the people buying marketplace insurance.

• The rate of uninsured children increased to 6% in 2024 after reaching a low of 4.7% in 2016. Uninsured rates are especially high among American Indian/Alaska Native children and Hispanic children.

Source: KFF Health News

ACIP reverses decision and delays vote

The Advisory Committee on Immunization Practice (ACIP) is in the second day of its two-day meeting, and chaos pervades. On Thursday, the committee voted to rescind its recommendation of the combination measles, mumps, rubella, and varicella (MMRV) vaccine in children younger than 4. This first dose is usually given to children ages 12-15 months. In place of this, children can receive separate varicella and MMR vaccines. ACIP did not change its recommendation for the second dose, which usually happens between ages 4 and 6.

The panel voted Thursday to continue to fund the cost of the MMRV shot through the Vaccines for Children program, which covers about half of U.S. children, but then reversed that decision Friday in a second vote. Some members Thursday said they were unclear of what they were voting on. The panel also postponed indefinitely a vote on the delivery of the hepatitis B vaccine to newborns. This is the second time ACIP has postponed a vote on hepatitis B vaccines.

In related news

Northeastern states are forming the Northeast Public Health Collaborative. The states will work together on public health efforts and issue joint vaccine recommendations. States involved are New York, Maine, Connecticut, Rhode Island, Massachusetts, Delaware, New Jersey, and, Maryland, as well as New York City. This echoes the West Coast Health Alliance of four states that has already issued vaccine guidance.

NIH to strengthen stillbirth research

Finally, near to my own heart, the National Institutes of Health plans to create a Stillbirth Research Consortium with $37 million in funding over five years. About 1 in 175 pregnancies in the United States ends in a stillbirth – 21,000 per year – and no cause is found in more than 50% of stillbirths.

The funding will support efforts to better understand the placenta, use AI to analyze health records and biomarkers for potential risk factors, and study the role of maternal health and fetal movement.

My second baby, Genevieve, was stillborn. I have written extensively about that experience, and she continues to shape my life. Just last week, my hair stylist asked about why I had become interested in maternal health, and I could see that she was digging for something. When I told her, she started crying and said that her best friend had just experienced a stillbirth. She didn’t know how to help. All this to say that once you’ve been through it, you become very aware of how many people it affects.

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Most people who have had one C-section will have another with any subsequent delivery. C-sections come with higher risks of infections, blood clots, and dangerous blood loss than vaginal births, so why are repeat C-sections nearly obligatory?

For people who have had a C-section, three modes of delivery can happen with subsequent babies. The birthing person can choose to have a planned repeat C-section, can try labor after C-section (LAC) and hope that ends in a vaginal birth (frequently known as a VBAC), or can try LAC but end up with an unplanned repeat C-section.

Research has shown that mothers face a lower risk of negative outcomes with a VBAC than with a repeat C-section. But when LAC ends in an unplanned repeat C-section, risks for both mothers and babies go up. This makes doctors and hospitals reluctant to have mothers even try for a VBAC. In 2021, the VBAC rate stood at 14.1%, which was an increase from its lowest point of 8.3% in 2007 but well below rates in the 1990s, which reached as high as 28.3%. The overall C-section rate is 32.3% in the United States.

In addition, pregnant people in many areas of the country are losing the choice of a doctor or hospital. Hundreds of rural hospitals have closed their maternity units in recent years, and 35% of counties in the United States are maternity care deserts, with no hospitals or birth centers and no obstetric providers. People who are driving an hour just to reach the nearest hospital only have the option of a VBAC if that hospital allows it. The forthcoming Medicaid cuts passed over the summer are expected to lead to even more maternity unit closures.

Brittany Ranchoff, a research fellow at the Harvard Pilgrim Health Care Institute and Harvard Medical School, investigates access to obstetric care and is the lead author of “Trends in Labor After Cesarian Delivery Access in the US,” which was published recently in the journal JAMA Network Open.

Ranchoff spoke with Woman Child Health about the findings of her research, in which she looked at LAC access in every county in the continental United States from 2016 to 2021. She also discussed how guidance to doctors on LAC has changed over time and how more providers might be encouraged to offer LAC. This interview has been edited and condensed.

Woman Child Health: Can you talk about how you became interested in studying trial of labor after cesarean sections?

Ranchoff: I'm interested in the factors that impede and impact the ability to choose a clinician. I was really wanting my dissertation to focus on access to care and determining access and looking at some of the factors that might impact choosing a clinician.

I knew many pregnant people did not have a choice about their subsequent delivery mode after a prior cesarean. Understanding LAC access in the U.S. preserves pregnant people's choice about method of delivery in their next pregnancies, and it's essential in ensuring all individuals can access their desired services as well as health outcomes.

I believe all birthing people should have a choice in clinician, and further, should have the ability to have a VBAC if that is reasonable for them.

Woman Child Health: Can you talk about what the current clinical guidance is around this?

Ranchoff: So, the optimal management for a subsequent delivery after a prior C-section has been debated in the U.S. for years. Before talking about the current clinical guidelines around labor after cesarean, I think it's important to talk about the history of VBAC in the U.S.

In the 1970s, the cesarean rate was only 5.5%, and then it increased to 16.5% in the 1980s. This rapid increase in the cesarean rate created a greater urgency about delivery mode after cesarean.

ACOG, that’s the American College of Obstetricians and Gynecologists, published a series of VBAC guidelines, which expanded its utilization. And in addition, with the growth of managed care in the 1990s, LAC was identified as a mechanism to reduce the cost, and some managed care organizations required individuals to undergo LAC.

In 1998, ACOG revised its guidelines surrounding VBACs based on a widely publicized study that showed individuals undergoing LAC were almost twice as likely to experience a major maternal complication compared to a planned repeat cesarean — and rising malpractice concerns about LAC. The VBAC rate plummeted, and the overall cesarean rate rapidly increased during the 2000s.

So, in 2010, the National Institutes of Health convened another consensus conference, which put forth recommendations regarding LAC, and as a result, ACOG changed their clinical guidance to encourage LAC.

ACOG says that VBAC is a reasonable option for most people with a prior cesarean and may be considered for birthing people with more than one cesarean depending on other risk factors.

Woman Child Health: I feel like you've touched on this a little bit in the history, but why are doctors and hospitals reluctant to offer this?

Ranchoff: We know many clinicians and hospitals do not offer LAC services due to changes in clinical practice guidelines and liability concerns. As we know, the clinical guidelines have become somewhat more encouraging of labor after cesarean around 2010.

For many people, there might be clinical benefits and better outcomes to having a VBAC, so it should be an option for more pregnant people with a prior cesarean. Yet, there's this lag in access catching up with this.

And one of the main concerns for clinicians and hospitals is around this liability, and if there is someone attempting a VBAC and it ends in a negative outcome. Also, typically, a planned repeat cesarean is more convenient for the clinician and the hospital.

Woman Child Health: So, when you looked at this on a national level, what did you find?

Ranchoff: We found that, overall, 15.9% of U.S. counties had LAC access over the study period. Metro counties were more likely to have LAC access than non-metro counties. There was a higher proportion of counties in the Northeast and West regions of the U.S. that had LAC access than in the South and Midwest regions.

We also conducted an analysis limited to counties with an obstetric hospital, and among counties with hospital-based obstetric services, only 30.9% had labor after cesarean access.

Woman Child Health: And what does this mean for birthing people?

Ranchoff: Despite the U.S. VBAC rate slightly increasing in recent years, the results suggest that LAC has become more concentrated in a smaller set of hospitals or clinicians that are increasing their LAC and VBAC rates. Further, our findings confirmed the difficulty birthing people have expressed in accessing LAC services. Overall, access is not expanding, at least at the county level.

In addition, this limited availability of hospitals and clinicians offering LAC may mean that some people are traveling farther to access obstetric services or even bypassing their nearest obstetric hospital to access LAC. Many people with a prior cesarean are interested in LAC; however, many are denied this option, and some individuals will go to extreme lengths to attempt LAC, such as transferring hospitals or changing clinicians.

Those measures are only available to those with the resources to pursue them. So, if you are low income and can't afford to travel, or you have children and don't have somebody to take care of your kids, then it might be harder to travel even farther to have your baby.

Woman Child Health: What policies or strategies do you think could increase the availability of trial of labor after cesarean or VBACs?

Ranchoff: Prior research has demonstrated that national LAC guidelines have limited impact on increasing LAC and VBAC rates compared to local and regional LAC guidelines, such as changing hospital policies.

Given childbirth is the most common reason for hospitalization, and health care costs associated with C-sections are high, LAC could be a potential strategy to decrease cost. And childbirth often uses these bundled payment models where payments for prenatal care differ based on the method of delivery. As a result, there may be financial incentives for providers and hospitals to encourage planned and repeat cesarean delivery, especially among individuals with private insurance.

A recent study found that higher hospital profits per cesarean are associated with increased likelihood of cesarean delivery.

Two things that I can think of is talking with clinicians and hospitals about changing their policy regarding LAC access, as well as there could be insurance benefits and incentives that could potentially encourage this for people who are likely good candidates for VBAC.

Woman Child Health: Yeah, that is interesting. I had not thought about the financial side. I realized that it's costing families more to have a cesarean section, but I hadn't thought about the profits on the hospital side.

Ranchoff: They usually get more for cesarean delivery than they get for a vaginal delivery. And then with C-sections, you don't have to spend the time laboring, so you have that incentive as well.

Thank you for talking with us, Dr. Ranchoff!

Readers, who would you like to see interviewed next? Please leave a note in the comments.

The governor’s proposal includes raising base pay for child care workers to $18 an hour and the establishment of a loan fund to help with construction and expansion of facilities. Critics have questioned why the free care is being extended to high-income families and noted that child care enrollment among low-income families decreased in the state when free care was expanded to middle-income families.

A recent survey found that most adults, regardless of political party, view the cost of child care as a major problem. The map below shows the gap between demand for affordable child care spots and available supply.

Source: Childcaregap.org

French Gates increases women’s health funding

Melinda French Gates announced that her foundation, Pivotal, will partner with nonprofit Wellcome Leap to invest an additional $100 million in women’s health research. The money will go toward studying areas of highest need, including cardiovascular health, autoimmune diseases, and mental health. Historically, women have been overlooked in scientific studies, with findings from studies on men assumed to apply to women.

Why is this important?

• A review of clinical trials of cardiovascular disease found that women had been underrepresented in most trials between 2010 and 2017, with women often making up less than 30% of study participants.

• Women are far more likely than men to have autoimmune diseases, with an estimated 80% of cases occurring in women. In addition, autoimmune diseases are becoming increasingly common, and this is not solely because of increased awareness. Well-known diseases such as Type 1 diabetes are also increasing.

• In 2023, research on women’s health accounted for less than 8% of the budget of the National Institutes of Health. This is to say that studies of health conditions specific to or disproportionately experienced by women, as well as the ways in which women have different symptoms of health conditions, are receiving little funding.

If you would like to read much more about the ways in which science treats men as the default, I recommend “Invisible Women” by Caroline Criado Perez. You may want to read it in small doses as it is disheartening.

MAHA report on children’s health released

Robert F. Kennedy Jr. released the government’s report on how to improve the health of U.S. children. The report focuses on asking companies to voluntarily commit to reducing ultra-processed foods, funding more studies of chronic disease, and increasing physical activity, including bringing back the Presidential Fitness Test in schools. The report also calls for changes to the child vaccine schedule and addressing vaccine injuries.

I have clear memories of doing the Presidential Fitness Test in school, a series of challenges including pull-ups and a one-mile run that were performed in front of your classmates. This boosted the confidence of kids who were already athletic and embarrassed the rest, making them loathe gym class even more.

NPR has a history of the Presidential Fitness Test, which began in the 1950s and was phased out in 2013. Even in the 1950s, U.S. students did poorly on this test compared to European students, with 58% of U.S. children failing at least one portion of this test compared to about 9% of European children. The researcher at the time noted that the U.S. had no wish to change its automobile-centered society but would need to come up with some way to get U.S. kids to be more active. Hmmm.

Funding cut for students with vision and hearing loss

The U.S. Department of Education has cut funding that provides supports to students who have both vision and hearing loss. The funding of about $1 million total to eight states is used to train families and educators to help these students. About 10,000 children and young adults are deafblind nationally. A spokesperson for the education department said concerns about “fairness” were the reason for the funding cut.

I should say more, but I cannot process this level of inhumanity.

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Doctors have long recommended acetaminophen over other pain medications during pregnancy because it has been found to be the only medication without increased risk of miscarriage or birth defects.

Important takeaways:

• None of the studies establish causation. To establish that acetaminophen causes autism, researchers would need to run a randomized control trial that assigned some pregnant people to take acetaminophen and some to take a placebo and then checked on rates of autism years later. It’s unethical to assign pregnant people to take medications that might be dangerous to the fetus.

• Given the impossibility of a randomized trial, studies of this issue are observational and rely on mothers self-reporting their use of acetaminophen during pregnancy.

• When the researchers compared siblings in which one child was exposed to acetaminophen in utero and another was not, they found no increased risk of autism among the sibling exposed to acetaminophen. Many other factors including genetics and environmental exposures are believed to play a role in autism.

• Untreated fever and pain also pose risks to the mother and fetus, including preterm birth and neural tube defects, so eliminating the use of acetaminophen is not recommended unless a safer alternative is found.

In related news

ProPublica has an excellent story on the government scientists who have studied the link between autism and environmental contaminants for decades and have now been fired by the Trump administration. Their research, which repeatedly found that parent exposure to chemicals prior to or during pregnancy led to an increased likelihood of children developing autism, has been canceled. Kennedy has said that $50 million in new funding for autism research will allow the government to do “real studies” for the first time. The story shows how decades of learning have been disregarded at a time when the government is also eliminating environmental protections critical to reducing the risk of autism, among many other health concerns.

Government pulls back report on alcohol

The Department of Health and Human Services will not release a report that shows cancer risk increases with even small amounts of alcohol consumption. Instead, the department, which is crafting new dietary guidelines, will rely on a report issued by a panel from the National Academies of Sciences, Engineering and Medicine that says moderate drinking is healthier than abstaining. That panel included people with financial ties to the alcohol industry. For now, a draft of the report indicating the dangers of limited alcohol consumption is available online.

Regardless, Americans seem to have gotten the message that drinking has negative effects on their health. A Gallup survey released in August found that only 54% of people reported consuming alcohol, the lowest level since the survey began in 1939.

Source: Gallup

Texas bill targets abortion pill providers

The Texas Legislature passed a bill last week that would allow private citizens to sue anyone who provides abortion medication coming into or out of Texas. Texas Gov. Greg Abbott is expected to sign the bill, which will likely serve as a model for other states with abortion bans. The bill sets up a legal battle with states that have created shield laws to protect doctors who prescribe abortion medications to out-of-state patients. It makes exclusions for Texas hospitals and physicians who practice only inside the state and for those distributing the medication to treat emergencies including ectopic pregnancies and miscarriages.

Breastmilk cues babies on sleep

A study published last week found that hormones in breastmilk fluctuate over the course of the day in relationship to circadian rhythms. The scientists looked at breastmilk collected across four timepoints each day and found that melatonin, which promotes sleep, was highest in the milk collected at midnight, while cortisol, which regulates energy use and is tied to alertness, was highest at 6 a.m.

Given that breastmilk appears to help infants regulate their sleep cycles, the scientists suggested that people who are pumping breastmilk may want to label the time of day it was collected so that it can be fed to the baby at the same time of day.

But also? I have been that working mom who is pumping breastmilk in a locker room — a room last used by a sweaty fellow who biked to work mid-summer — while hoping that the lock on the door isn’t broken and trying to return to my desk as quickly as possible. So really, this is one more argument for the United States to implement universal paid maternity leave like nearly every other country on Earth.

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The next meeting is scheduled for September 18 and 19, although Sen. Bill Cassidy, who leads the Senate Committee on Health, Education, Labor, and Pensions, has called for the meeting to be postponed because of questions being raised about the lack of scientific process in making decisions about vaccines. Cassidy is a doctor and was instrumental to Kennedy’s confirmation to his post.

Given Kennedy’s history of questioning the measles vaccine, we may see more alarming decisions from this meeting.

Coping with COVID-19 vaccine confusion

CNN has a helpful explainer on who can receive COVID-19 vaccines amid the new guidance from ACIP. The guidelines now approve the vaccine for those 65 years and older, as well as for those under 65 who have conditions that put them at higher risk of severe illness. The FDA commissioner has said anyone can still receive the vaccine if they request it from their doctor.

CVS Pharmacy is hoping to have vaccines available this week in most locations. However, COVID-19 vaccines will not be available at its clinics in 16 states due to regulatory hurdles. In most of those states, people can still receive the vaccine if they get a prescription for it from a health care provider.

Will insurance cover the shot?

In most cases, we don’t know. Medicare and Medicaid must still cover it for people who qualify under the ACIP recommendations. The Affordable Care Act requires insurers to cover vaccines for adults when the vaccines are recommended by ACIP, so it is no longer clear that this must be covered for people who do not fall into the high-risk categories.

In related news

• The Florida state surgeon general says the state plans to eliminate all childhood vaccine mandates. This was just announced, and I imagine we will hear more in the coming days.

• KFF Health News explains why pediatricians typically don’t make a profit from vaccinating children. In fact, they often lose money. While vaccines may be provided to doctors for free through a federal program, medical offices must pay for medical-grade refrigeration, insurance on the many vaccines they store, and generators in case of a power outage.

• COVID rates have been steadily increasing, according to CDC data. Test positivity rates and hospitalizations have risen the past few weeks, with the greatest increase in the south-central U.S. Detection of the virus in wastewater is very high in Alabama, Hawaii, Louisiana, Nebraska, Nevada, South Carolina, Texas, Utah, and Washington, D.C.

Source: CDC

Government health web pages to be restored

Good news! As part of a lawsuit settlement, the Trump administration will restore government health and science web pages that were taken down earlier this year. The removed pages provided information on pregnancy and reproductive care, LGBTQ+ health, transgender youth, vaccines, opioid-use disorder, racism in health care, and other topics. Doctors said that having a centralized location for this information is essential to keep up with recommendations and deliver quality health care. The administration has not said when the websites will be back online.

Minnesota Legislature to be called back over school shooting

Minnesota Gov. Tim Walz will call a special session of the legislature to discuss gun laws after the school shooting in Minneapolis last week that killed two children and injured 21 people. The governor did not go into detail about potential legislation but said options could include safe storage, improvements to the state’s red flag law, and more funding for mental health.

As a reminder: Most shootings of children occur in homes, not at school, but school shootings are acts of terrorism that draw media attention and thus can forge political will to address this crisis.

Both the Minnesota House and Senate are nearly evenly divided between the political parties, meaning some Republicans would need to vote with Democrats for legislation to pass. The House is expected to return to a 67-67 tie between parties after a special election this month to fill the seat of Rep. Melissa Hortman, who was assassinated along with her husband and dog in June. (This is the point in writing this newsletter where I began to cry. This is all too much.)

We know the problem and the solution

• Guns have been the leading cause of death among U.S. children since 2020. An analysis found that guns caused 20% of all U.S. child and teen deaths in 2020 and 2021, compared to less than 2% of child and teen deaths in similarly wealthy countries.

• There have been 152 school shootings in the U.S. in 2025, which puts us on track to have fewer than last year, when 336 were recorded. The fact that we allow hundreds of school shootings year after year is appalling.

Source: K-12 School Shooting Database

• We have abundant evidence within our own states that stronger gun safety laws save lives.

• A bit of positive news: Gun sales have been declining since reaching a peak early in the COVID pandemic.

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The American College of Obstetricians and Gynecologists (ACOG) recommended late last week that all women who are pregnant, planning to become pregnant, or nursing receive a COVID-19 vaccine this fall. This contradicts CDC guidance, which was changed over the summer to remove the recommendation for a COVID vaccine for pregnant women and for children.

This follows the American Academy of Pediatrics (AAP) also countering the CDC guidance by recommending COVID-19 vaccines for children ages 6 to 23 months. Extensive reviews of available research by these organizations have found that COVID-19 vaccines are safe for these groups and reduce the risk of serious illness.

Why are these organizations contradicting the CDC?

• Women who had COVID-19 during pregnancy prior to the widespread use of vaccines had higher rates of maternal mortality, preeclampsia, and preterm birth.

• Hospitalizations of infants for COVID-19-related problems, including preterm birth, decreased much earlier in areas with high vaccine uptake compared to low vaccine uptake.

• As COVID-19 immunity wanes, boosters can help protect moms and babies. When a woman receives a vaccination while pregnant, some immunity is passed to the baby in utero.

• Insurers typically base their coverage of vaccines on official guidance, and along with its vaccine recommendations, the AAP urged insurers to continue to cover these shots.

The problem with these conflicting recommendations, of course, is that women and parents are left to decide who they trust, and they now may think that all this guidance is suspect. The bottom line is that the professional organizations continue to base their recommendations on data, while the CDC is following the political whims of Robert Kennedy Jr.

CDC failed to respond to measles crisis

An investigation done by KFF shows how the CDC failed to respond to pleas for help from local public health officials early in the Texas measles outbreak last winter. Emails bounced back and forth between local health officials, state officials, and the CDC as the local officials sought advice on how to contain the outbreak, obtain testing supplies, and persuade families to vaccinate their children. The CDC did not respond to these requests until the first measles death was reported in late February. Though the Trump administration’s official freeze on CDC communications ended February 1, CDC employees said they had not received a go-ahead to resume communication and feared losing their jobs.

The outbreak that began in Texas has now led to at least 4,500 cases of measles and 16 deaths across the western U.S. and Mexico. While measles cases have trended downward since spring, 42 U.S. states have reported measles cases this year.

More states ban student phones in schools

My state of North Carolina is one of 17 states where students have new restrictions on cell phone use as they return to school. The restrictions range from full bans of cell phone use throughout the school day to state requirements that each school district develop a policy on school cell phone use. For my middle schooler, phones and smart watches must stay out of site for the full day, while my high schooler is allowed to have a phone out at lunch only. Anecdotal, but every parent I have talked to is happy with this policy, save worries about coordinating last-minute changes to afternoon schedules.

Source: The Associated Press

Research on the health effects of children’s device use is mixed but overall points to increasing rates of depression and behavior problems as device use increases. Tech proponents point out that it’s difficult to determine causation with these studies. For example, teens who are inclined toward depression may be more likely to spend time on their devices because of that depression, which does not mean the device is the cause. However, we have seen declines in teen health and education outcomes since smart phones became widely used, and it’s difficult to make the case that these devices are essential to education.

Judge okays defunding of Maine health care provider

A federal judge cleared the way for the halting of Medicaid reimbursements to a group of reproductive health clinics in Maine. Maine Family Planning operates 18 clinics in Maine that provide about 8,000 residents with primary care, family planning, and reproductive health services including cervical cancer screenings. The clinics provide abortions but are already forbidden from using Medicaid funds to cover that service. Maine Family Planning said that the loss of funding will mean that it must cut primary care to hundreds of people.

Why is this important?

• About 20% of women view their OB/GYN as their primary health care provider, especially women who are planning to become pregnant or have recently been pregnant.

• One study found that women reported being more honest with their OB/GYN than their primary care provider. However, this study may have been biased because it was conducted with patients at OB/GYN offices.

• Maine is one of the most rural states in the country, and 13 of its 16 counties have a shortage of health care providers.

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Among the home- and community-based care services Medicaid covers are in-home nursing and therapy, the purchase of medical equipment, and the addition of home modifications that allow people to live at home rather than in institutions. The law does not require states to provide these home- and community-based services, so states often reduce Medicaid funding for these services when they face tight budgets, as they are expected to under the new policy.

Why is this important?

• Among people with disabilities, 35% rely on Medicaid, compared to 19% of people without disabilities.

• Parents of children with disabilities are more likely to experience physical and mental health challenges and more likely to reduce their hours at work or leave the workforce altogether.

• Following a reduction in federal Medicaid spending in 2011, states cut an average of 22% from funding for home health care and reduced the number of people who received services to address budget shortfalls.

• The 2011 Medicaid cuts led to an increase in people with disabilities being put on waitlists to receive services.

Potential changes to education services as well

The Supreme Court last week cleared the way for the Trump administration to continue its dismantling of the Department of Education by lifting a lower court ruling that had halted layoffs of department employees. Among the responsibilities of the department are overseeing funding for the Individuals with Disabilities Education Act (IDEA).

IDEA works to provide free public education to the approximately 15% of students ages 3 to 21 years who have a disability, as well as early intervention services for infants and toddlers identified as having a disability. IDEA serves nearly 8 million children annually. Among services provided through IDEA are physical therapy, occupational therapy, and speech and language therapy.

The administration has suggested it might put other departments in charge of these responsibilities but has not provided details nor commented on how funding might change. The percentage of public school students served by IDEA ranges from 12% in Idaho and Hawaii to 21% in Maine, New York, and Pennsylvania.

Source: National Center for Education Statistics

Scorecard shows contraceptive availability

A new scorecard released by the nonpartisan Population Reference Bureau (PRB) shows how easy or difficult it is for people to access contraception in each state. The report found that 16 states and Washington, D.C., were protective of access, 16 were restrictive, and the remainder fell in the middle.

Source: Population Reference Bureau

PRB looked at three categories to determine access: affordability, availability, and environment of care.

• Affordability policies included Medicaid expansion and whether states require insurers to cover contraceptive methods without a co-pay.

• Availability included who can prescribe contraceptives, availability of emergency contraception, and whether states require Medicaid and private insurers to provide an extended 12-month supply of contraceptives.

• Environment of care included whether minors can access contraceptive services without parents being informed, whether a state permits providers to refuse contraceptive services on religious grounds, and whether a state mandates medically accurate sex education.

The authors noted that, in some cases, states simply lacked policies related to these factors, which would allow restrictions even if that wasn’t what the state intended. Both conservative and liberal states fell into the group ranked somewhat restrictive.

Forever chemicals in reusable period products

A study of reusable period products including period underwear, menstrual cups, and reusable pads found high amounts of per- and polyfluoroalkyl substances (PFAS) in some products. I’m a bit reluctant to sound the alarm here because these substances are so prevalent in our society and cannot be avoided, but this is certainly good information to have when deciding which products to use. We have limited research on how much PFAS can be absorbed through skin, and researchers are pushing for further study.

Exposure to PFAS is associated with many health problems, including decreased fertility, developmental delays in children, and increased risk of some cancers.

Delivering vaccines via dental floss

On to some good news: Researchers have successfully delivered flu vaccine to mice with a special type of dental floss. Do you want to know more about flossing mice? The story at Science has the details. The researchers also successfully delivered the dental floss flu vaccine to a small group of human volunteers. This may someday become an alternative to vaccines via needle.

Measles update

As of last week, the CDC had reported 1,309 measles cases for 2025. I’ve included the CDC graph showing annual cases since 1985. While cases continue to be lower than they were before measles was declared eliminated in the United States, we have much to lose if we continue the trend of decreasing vaccinations.

Source: CDC

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Journalists are digging into the reasons that a Texas summer camp was situated in a floodplain. Among the findings: Flood maps created by FEMA were based on risks associated with storm surge and large river flooding while failing to consider the risks caused by heavy rainfall and flash floods. FEMA is aware that its maps are deficient, according to an NPR story, but lacks the funding from Congress to address the problem.

Data suggest that at least four of the cabins where girls slept at Camp Mystic were in an area considered an extreme flood hazard.

A separate story discusses failed attempts by Kerr County to gain funding for an emergency alert system because officials recognized that dangerous flooding was highly likely. The Texas Hill Country is full of creeks and low-water crossings, and I remember feeling fearful driving there even during a brief thunderstorm. About 12% of land in Texas is prone to flooding, and the state has had the highest number of flood-related deaths among all states in the past decade. North Carolina is second behind Texas.

Source: Texas Tribune

Why talk about this in a health newsletter?

Our health is intertwined with the environment in which we live. Climate change is driving an increase in environmental calamities, including floods, hurricanes, wildfires, and extreme heat. In addition to endangering people, a disaster like a flood can lead to housing and food insecurity, damage infrastructure essential for plumbing and clean water, and interfere with the ability of people to access medications and health care.

Among the health effects of flooding are increased injuries including carbon monoxide poisoning, increased infectious and parasitic diseases, exacerbation of noninfectious illnesses, and increased psychological distress. Babies and children are more vulnerable to the effects of these climate events.

Moving in the wrong direction

Amid the emergencies this past week, the federal government has taken down the national climate assessments (blank page here) that state and local governments use to assess risk and prepare for climate change. Congress mandates that an updated report be published every four years, but in April, the Trump administration fired the federal workers who coordinated the work of a team of volunteers putting together the next version, which was to be released in 2027.

Pretending that climate change doesn’t exist will, of course, do nothing to prevent the immense changes coming our way. Providing information allows communities to build homes and infrastructure that are less likely to be in harm’s way and to develop warning systems and safety plans for dangerous events.

The president has also proposed eliminating FEMA in its current form and greatly reducing the funding it provides to states after disasters. It’s unclear what this would mean for coordinating responses to disasters that span multiple states. Additionally, states such as California and Florida have an outsize number of disasters that require funding. We should be having conversations about how long we can sustain communities that are continually at risk and what resettlement might look like, and that conversation isn’t happening at the national level.

Preventive services meeting delayed

The Department of Health and Human Services cancelled the meeting of the Preventive Services Task Force scheduled for this week. The task force, which is comprised of volunteers who are usually shielded from political partisanship, meets three times annually to recommend preventive services. The Affordable Care Act requires insurers to cover these services, which include cancer screenings and medications to prevent HIV.

The move is raising concerns that Robert Kennedy may change the composition of the group, much as he did with the vaccine advisory panel.

Measles update

On Friday, the CDC had reported 1,288 confirmed measles cases, which is the highest number the United States has seen since measles were declared eliminated in 2000. This is worrisome not solely because measles is an extremely contagious illness that can be fatal but also because it signals that diseases may return as vaccination rates drop.

When we think about infectious diseases, we tend to focus on unvaccinated schoolchildren, but many other groups of people will be affected. Some physicians have never had to treat these illnesses because they were essentially eliminated decades ago. Medical training programs are looking at updating requirements to ensure staff have expertise in recognizing and treating illnesses that they may not have encountered in person.

Infants, immunocompromised people, and pregnant people are not eligible for some vaccines, and some of these preventable diseases cause birth defects, miscarriages, and stillbirths when contracted during pregnancy. People not vaccinated during childhood will need to be educated about these risks when they reach adulthood.

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Among its provisions are a work requirement for people receiving Medicaid and nutrition assistance from SNAP. The bill also would restrict taxes that many states impose on medical providers, a tactic that states have used to receive greater federal funding for Medicaid (The New York Times has a good explainer on this process).

I’m sure we will see many stories in the coming days on the full details of the bill should it pass the House.

Abortion laws lead to dangerous miscarriages

An investigation by ProPublica found that the number of women needing blood transfusions in the emergency room after a first-trimester miscarriage increased 54% in Texas after the state banned abortion. The dilation and curettage (D&C) procedure used to clear the uterus after a miscarriage is the same procedure used during an abortion, and doctors are now waiting longer to intervene with miscarriages for fear of prosecution.

Source: ProPublica

Often, a woman will begin having signs of miscarriage, including heavy bleeding, when an embryo or fetus still has a heartbeat. The story notes that, in some cases, women whose pregnancies were determined to be nonviable were not offered D&Cs, which are standard care for a miscarriage and the most effective way to stop hemorrhaging. (Interesting aside: Part of this story was reported at the hospital where I delivered my youngest child.)

Why is this important?

• An estimated 10% to 20% of pregnancies end in miscarriage. That’s well over 500,000 miscarriages each year based on the nearly 3.6 million births in the United States in 2023.

• The United States has no law requiring paid sick leave, and without medical intervention, a miscarriage may take from a few days up to multiple weeks.

• Women who experience miscarriage have elevated rates of depression and anxiety in the months afterward, and receiving poor-quality care is a risk factor for these conditions.

My take: It’s unconscionable that these laws are preventing women who are going through severe physical and psychological pain from receiving the care they need.

Vaccine committee meets

The seven new members of the Advisory Committee on Immunization Practice (ACIP) decided last week to remove the longstanding recommendation for flu vaccines that contain the preservative thimerasol. Only 4% of flu vaccines — those that come in multidose vials — still contain thimerasol, which has trace amounts of mercury. These shots from multidose vials cost a fraction of what a single dose packaged in a syringe costs.

Robert F. Kennedy Jr. has long maintained that the preservative is linked to autism, though research has found no connection, and autism rates have continued to increase since the preservative was removed from all childhood vaccines in 2001.

Other actions:

• ACIP recommended the flu vaccine for everyone age 6 months and older.

• ACIP voted to approve clesrovimab, which protects infants from respiratory syncytial virus (RSV), and to recommend it as part of the children’s vaccine program. Clesrovimab is a monoclonal antibody, not a vaccine, meaning that it is a lab-made copy of an immune system antibody that fights off infection. Receiving these antibodies stimulates the human immune system.

• The committee announced that a new working group would investigate long-approved vaccines to decide whether children are receiving too many shots.

Florida requires heart test for student athletes

A new law takes effect in Florida today that requires all high school students who want to compete on school sports teams to receive an electrocardiogram (EKG). School districts must provide a low-cost EKG to all students competing in sports, and families will be allowed to opt out for religious or medical reasons or if their school district does not provide an EKG for $50 or less.

Previous research that looked at data for 36% of all U.S. high school athletes found 104 cases of sudden cardiac arrest over the course of six years, with the authors noting this was likely an undercount. Male basketball players were most likely to experience cardiac arrest, followed by male football players; 88% of all heart events occurred in males.

Measles update

On Friday, the CDC had reported 1,227 confirmed measles cases, with 95% of those occurring in unvaccinated people.

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Direct care work is the fastest growing job sector in the United States, and already, facilities and staffing companies report worker shortages. Direct care workers include personal care aides, home health aides, and nursing assistants. In 2022, the median annual wage for direct care workers was $25,015. The care provided is largely funded by Medicaid and Medicare, and the budget bill currently before the Senate could dramatically reduce Medicaid spending. Experts note that low pay, lack of respect, and the physical demands of the job lead to high turnover.

Why is this important?

• Research has found that increased immigration leads to improved staffing at nursing homes and better patient outcomes.

• Family caregivers for seniors are more likely to report poor physical health, depression, and exhaustion than people who are not caregivers.

• When families cannot find or afford to hire caregivers, female family members typically take on the work. Women do the majority of unpaid caregiving in the United States, with women over the age of 55 doing 35% of all unpaid caregiving for seniors.

Source: Department of Labor

If you would like to read more, The New York Times has a distressing piece (gift link) about a caregiver for an adult with autism who was sent to a detention facility.

Vaccine committee meets this week

The reconfigured Advisory Committee on Immunization Practices (ACIP) is set to meet Wednesday and Thursday to discuss a shortened list of items including COVID-19 shots, fall flu vaccinations, RSV vaccinations for pregnant women and children, and the use of the preservative thimerasol in flu vaccines. Thimerasol contains trace amounts of mercury and was removed decades ago from all vaccines for children younger than 6, except for multi-dose vials of flu shots, which are rarely used.

Republican Senator Bill Cassidy, who is a doctor and chairman of the Senate Health committee, called for Kennedy to postpone the meeting because of the lack of members with expertise in microbiology, epidemiology, and immunology and the lack of a CDC director to approve the panel’s recommendations. Kennedy has appointed only eight new ACIP members to replace the 17 that he fired.

ACIP sets the schedule for children’s vaccines and provides guidance for adult immunizations after the FDA has approved a treatment. Insurers use these recommendations to decide which vaccines to cover. ACIP was scheduled to discuss other vaccines, including shots to prevent HPV and meningococcal bacteria, but the agenda released last week doesn’t include those items.

Possible alternatives

Professional medical organizations and researchers are considering forming their own group to make vaccine recommendations. Michael Osterholm, who is director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, is creating a group called the Vaccine Integrity Project as a possible alternative to ACIP. CIDRAP has been consulting with organizations including the American Academy of Pediatrics and the American College of Physicians and with insurance providers about vaccine recommendations.

Antibiotics in infants tied to infections later

A recent study that followed more than 20,000 children found that exposure to antibiotics in the first week of life was associated with an increased risk of respiratory infections, gastrointestinal infections, and urinary tract infections in early childhood.

The study grouped the children based on type of birth (C-section vs. vaginal) and timing of antibiotic exposure (before birth, after birth, or never). Mothers having C-sections typically receive antibiotics before or during the surgery, and mothers with vaginal deliveries often are given antibiotics to prevent Group B Streptococcus infection in their infants. Research has found that administering antibiotics after the umbilical cord is clamped during C-sections — thus preventing infant exposure— does not increase the risk of surgical infections in mothers.

The researchers do not know how the exposure interfered with the immune system but believe that antibiotics impede the development of a healthy microbiome.

Judge delays public health funding cuts

Last week, a federal judge intervened to prevent the Trump administration from pulling back a total of nearly $33 million in public health funding in Houston, Columbus, Nashville, and Kansas City. The administration has argued that the funding granted during the COVID-19 pandemic to strengthen public health infrastructure is no longer needed. The judge ruled that the administration cannot remove funding while the case is being litigated.

The cities have used the funding for wastewater surveillance to track outbreaks, hiring community health workers, and running vaccination campaigns.

Measles update

On Friday, the CDC had reported 1,214 confirmed measles cases, with 95% of those occurring in unvaccinated people.

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