Policy & Practice Newsletter

Reflecting on NPWH's Efforts for May & June 2024

Dear NPWH,

Please enjoy this newsletter, which offers updates on NPWH's advocacy, policy, and practice efforts representing the organization and the certified women's health nurse practitioner profession.

The National Association of Nurse Practitioners in Women’s Health (NPWH) is seeking input from our members.

As a membership organization, our members are our most valuable asset. Your experiences and insights are crucial in helping us understand the challenges you face as certified WHNPs and advanced practice providers, and the obstacles encountered in delivering healthcare.

We kindly request 15-20 minutes to share your feedback and insights with us through this survey. Please take the survey here. Deadline: August 7

Participation Incentive

All respondents will be entered into a drawing to win complete registration to the main conference at the 27th Annual NPWH Women's Healthcare Conference in Chicago. A second prize of a swag bag filled with NPWH logo items will also be awarded.

Your participation is greatly appreciated. Thank you for your time and valuable input.

With kind regards,

Heather L. Maurer, MA, CAE

Chief Executive Officer

The National Association of Nurse Practitioners in Women's Health

www.npwh.org

hmaurer@npwh.org

P.S. NPWH Volunteer Committee applications will open in August.

The Future for Women’s and Gender-Related Healthcare for Women’s Health Nurse Practitioners Komkwuan P. Paruchabutr, DNP, WHNP-BC, FNP-BC, CNM, FACNM,

President, the National Association of Nurse Practitioners in Women's Health (NPWH)

This commentary examines the future of women’s health and gender-related healthcare for Women’s Health Nurse Practitioners (WHNPs) within the framework of the National Association of Nurse Practitioners in Women’s Health’s (NPWH’s) mission and vision.

Emphasizing the importance of addressing menopause, maternal health, and reproductive health, it discusses the significance of WHNP education, certification, and workforce contributions. Despite their critical role, challenges, including recognition as maternity care providers and disseminating WHNP-specific outcomes, remain. WHNPs are vital in providing comprehensive healthcare for women and gender-diverse individuals.

Guided by the mission and vision of NPWH, WHNPs address key priority areas, including menopause, maternal health, and reproductive health. However, challenges such as recognition as maternity care providers, publishing outcomes specific to WHNP practice, and collecting comprehensive workforce data persist. To advance women’s and gender-related healthcare, concerted efforts are needed to address the challenges faced by WHNPs. This includes advocating for recognition within maternity care, promoting the dissemination of WHNP-specific research, and improving workforce data collection.

By overcoming these challenges, WHNPs can continue to play a pivotal role in promoting the health and well-being of women and gender-diverse individuals, shaping the future of women’s health and gender-related healthcare delivery.

Paruchabutr, Komkwuan P. DNP, FNP-BC, WHNP-BC, CNM, FACNM. The Future for Women’s and Gender-Related Healthcare for Women’s Health Nurse Practitioners. The Journal of Perinatal & Neonatal Nursing ():10.1097/JPN.0000000000000821, May 07, 2024. | DOI: 10.1097/JPN.0000000000000821

Read Full Commentary

NPWH Advocacy Priorities:

NPWH strives to make meaningful changes in women's and patients' lives through advocacy efforts that center on improving women's and gender-related health outcomes and the quality of healthcare for the patients you care for.

In keeping with our mission we:

Advocate for healthcare policies that support women and patients, and the nurse practitioners who care for them: and,
Collaborate with strategic partners to enhance the effectiveness and timeliness of our efforts in the policy and practice arena.

As our members witness daily, policy decisions related to everything from reimbursement for healthcare service delivery to state-based scope of practice regulations to decisions regarding the availability of services, medication, new technologies, and social supports affect women's health. Since our inception, NPWH has stood with patients and our colleagues who provide women’s and gender-related healthcare in respecting and defending individuals' rights to make their own reproductive health decisions and championing equitable access to the full range of reproductive health services.

NPWH Collaborative Efforts with

Like-Minded Organizations

NPWH Vision:

NPWH is the trusted champion and essential professional resource for certified Women's Health Nurse Practitioners and all advanced practice registered nurses who provide women's and gender-related healthcare. We value collaboration and build strong alliances with like-minded organizations and providers. The providers we serve are known experts in the primary, complex and specialty care of their patients, and are leaders and advocates in the advancement of healthcare toward a more just, healthy, and equitable world.

This newsletter highlights these priorities and our efforts as the national professional association giving voice to 13,000 certified WHNPs across the country supporting all APRNs who provide women's and gender-related healthcare.

NPWH Joins Leading Medical Organizations Call for the FDA to Permanently Remove Restrictions on Mifepristone

News Release | Jun 18, 2024

The following is a statement from the American College of Obstetricians and Gynecologists, joined by the American Academy of Pediatrics, the American College of Preventive Medicine, the American Medical Association, the American Society for Reproductive Medicine, the American Urogynecologic Society, the National Association of Nurse Practitioners in Women's Health, the Society for Academic Specialists in General Obstetrics and Gynecology, the Society of Family Planning, the Society for Maternal-Fetal Medicine, and the Society of General Internal Medicine:

For nearly two years, mifepristone has been under intense legal scrutiny as litigation that sought to restrict access to the drug, which is commonly used for medication abortion and miscarriage management, has moved through the court system. Throughout that judicial process, the medical community has repeatedly affirmed that mifepristone is safe and effective and that burdens and restrictions on mifepristone are not evidence-based.

The long-standing consensus about mifepristone’s record of safety makes clear that it is time for the FDA to permanently remove the remaining restrictions imposed on mifepristone under the risk evaluation and mitigation strategy (REMS). Our organizations urge the agency to do so with expedience.

Mifepristone is safe. Robust clinical evidence backed by decades of use by millions of patients has proven incontrovertibly that mifepristone is safe and effective for use in medication abortion and miscarriage management. Complications associated with mifepristone are exceedingly rare, minor, and easily treatable.

Critically, the REMS requirements do nothing to enhance the safety of an already safe drug; instead, they impose administrative burdens, exacerbate health inequities, and lead to delays in care.

Recent data have shown that more than six out of 10 people who seek abortion care opt for a medication abortion. Removing the REMS restrictions from mifepristone will help ensure that people who choose medication abortion can access the safe, effective care they need without needless barriers that are not grounded in science.

Throughout the legal process related to the mifepristone suit, the government’s lawyers, speaking on behalf of the FDA, have repeatedly argued for the safety and efficacy of mifepristone. It is now time to make good on that testimony through regulatory change.

Read the Statement

Access to Safe Abortion Care NPWH Clinical Position Statement

We affirm that abortion is an essential component of comprehensive reproductive healthcare and that it should be legal, safe, and accessible. Legislative and policy decisions should be firmly rooted in science, protect the patient-clinician relationship, and aim at reducing disparities to ensure equitable access to safe, effective, and timely abortion care.

Read our full clinical position statement, Access to Safe Abortion Care here .

Reproductive Health Advocacy Work and Updates:

In November 2023, NPWH joined ACOG, SMFM, AMA, and other leading medical and nursing healthcare associations in filing a new amicus brief in the case Zurawski v. Texas. The brief affirms the need to protect the ability of Texas clinicians to provide critical care to pregnant patients in medically complex cases. NPWH supports that clinicians must be able to exercise their discretion to care for patients experiencing medically complex and nuanced conditions to protect them from negative health outcomes. Unfortunately, as the testimony in this case shows, the Texas abortion bans (“the Bans”) are deterring Texas clinicians from providing and their patients from receiving critically necessary abortions, even when that care is essential to protect those patients’ lives and health. The Bans also threaten longstanding principles of medical ethics and patient autonomy and further exacerbate Texas’ shortage of medical professionals capable of providing obstetrics and gynecology (“OB-GYN”) care. This will leave countless Texans—whether or not they ever seek abortions—without access to quality OB-GYN care. The Texans who are suffering the most are those who experience discrimination due to race or ethnicity, have low incomes, and/or live in rural areas—individuals who already face inequities in the health care system. As a result, reversing the District Court will lead to a predictable increase in maternal mortality, already at a crisis rate, particularly for Texans of color. Read full amicus brief here.

Outcome: Texas Supreme Court Does Not Clarify Abortion Ban Exceptions

Outcome: Supreme Court Ruling Maintains Access to Mifepristone

Additional Resources & Research

Details of Sign On Letters & Other Advocacy Work

Letters of Support: These letters indicate NPWH’s support for initiatives and legislative and regulatory actions. They include joint statements regarding pertinent issues, such as the availability of the maternal RSV vaccine.

We joined numerous organizations in providing letters of support, including the National Family Planning & Reproductive Health Association, the Agency for Healthcare Research and Quality, Trust for America's Health, Healthy Women HPV Cancers Alliance, EveryBODY Covered, the Maternal Mental Health Leadership Alliance, Organizations in support of Sexual and Reproductive Health Equity, Power to Decide, Alliance for Women's Health and Prevention, ACOG, the American Liver Foundation and AcademyHealth.

Endorsements: We endorsed pieces of legislation including: the Treat and Reduce Obesity Act (TROA), National Defense Authorization Act, the Right to Contraception Act and the Right to IVF Act.

Letters of Request: These letters are directed to legislators, Cabinet members, and federal agency heads. They often include requests for funding for federal agencies, the nursing workforce and education.

NPWH supports efforts to highlight the role of the WHNP and APRNs who provide women’s and gender-related healthcare through various advocacy efforts to raise the profile of the profession and amplify the voice of the organization.

Below are highlights of some of the letters we have signed on and supported during May and June 2024.

NPWH is a proud member of The Nursing Community Coalition (NCC), which includes 64 members representing the cross-section of education, practice, research, and regulation within the nursing profession.

We joined NCC and signed on to the following letters sent to Congress:

NCC Sends Letter to Congress Outlining Top Legislative Priorities During National Nurses Week

On May 6, 2024, all 64 members of the Nursing Community Coalition (NCC) signed a letter urging Congress to take action on top appropriations and legislative priorities that impact nursing education, workforce, and research. This letter came during the celebration of National Nurses Week 2024.

NCC Submits Testimony to House and Senate Appropriations Subcommittees

On May 3, 2024, 58 members of the Nursing Community Coalition (NCC) signed onto written testimony submitted to the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education. The testimony featured the coalition's funding requests of at least $530 million for the Title VIII Nursing Workforce Development Programs and at least $210 million for the National Institute of Nursing Research for Fiscal Year 2025.

86 Representatives Support FY 2025 Funding for Title VIII in House Dear Colleague Letter

NPWH was pleased to see that on May 1, 2024, 86 Representatives signed onto the bipartisan House of Representatives Dear Colleague letter, requesting $530 million for Title VIII Nursing Workforce Development Programs in FY 2025.

Read below about our additional collaborations and sign-ons with other organizations.

Supporting the Affordable Care Act's Contraceptive Coverage

long word contraception from gray wooden small letters with black font on an orange background

NPWH recently joined with other organizations on a letter in support of access to high-quality family planning services, including FDA-approved contraception and contraceptive services.

The Affordable Care Act (ACA) requires plans to fully cover all Food and Drug Administration (FDA)-approved, -cleared, or -granted contraceptive products but an investigation by the House Committee on Oversight and Reform reported in October 2022, found that five of the largest insurers and four of the largest Pharmacy Benefit Managers (PBM) routinely required cost-sharing for certain birth control products or excluded them from coverage altogether. By covering all FDA-approved drugs and drug-led devices, plans will be deemed in compliance with the ACA’s contraception benefit and many of the barriers women are facing will be addressed. Read the letter here.

Treat and Reduce Obesity Act Supports Evidence-Based Care

NPWH is a charter member in support of the EveryBODY Covered campaign, whose primary focus is the Treat and Reduce Obesity Act (TROA). Obesity is a chronic disease that impacts the health and well-being of more than 1 in 3 American women. Even though the disease is associated with over 200 other health complications, Medicare does not provide coverage for some forms of obesity care.

TROA is bipartisan legislation that would provide Medicare beneficiaries with access to safe, effective and life-saving care for obesity. The bill aims to better support older Americans living with obesity by expanding the type of healthcare professionals who can deliver intensive behavioral (IBT) therapy and allowing Medicare Part D to cover Food & Drug Administration (FDA)- approved obesity medications. Learn more at everybodycovered.org and make your voice heard to your Congressmember by signing on here.

Agency for Healthcare Research and Quality

Enhances Preventive Healthcare

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 80-100 million Americans, many of whom remain undiagnosed. This condition is particularly prevalent in communities burdened by high rates of obesity, diabetes, and hypertension—factors that contribute significantly to liver disease. If MASLD remains unaddressed, it can progress to its more severe and deadly form, metabolic dysfunction associated steatohepatitis (MASH) which can lead to liver cancer and liver transplant. In fact, MASH is expected to become the leading cause of all liver transplantations in the U.S. by 2025.

The American Liver Foundation authored a letter in June, which NPWH signed along with other organizations, to secure critical funding for the Agency for Healthcare Research and Quality (AHRQ) in the Fiscal Year 2025 appropriations. AHRQ plays a pivotal role in enhancing healthcare quality, safety, and efficiency, which directly affects nearly 100 million Americans with liver disease. There is an urgent need for enhanced research funding from AHRQ to develop effective prevention, diagnostic, and treatment strategies. Increased support for AHRQ is vital as it benefits diverse populations, especially vulnerable groups within Hispanic, Black/African American, and Asian American and Pacific Islander communities, who face elevated risks and higher incidences of liver disease. Read the letter here.

Working to Improve Maternal Mental Health Conditions

Maternal mental health (MMH) conditions are the most common complication of pregnancy and childbirth, affecting one in five pregnant women or new mothers, or 800,000 American families each year, according to data from the CDC. Women of color and service members experience MMH conditions at nearly twice the national average, and young mothers and women of low socioeconomic status are also at higher risk of experiencing MMH conditions.

The MMHLA (Maternal Mental Health Leadership Alliance) in June authored a letter that requests funding and provisions to address maternal mental health in the Fiscal Year 2025 Labor, Health and Human Services, and Education Appropriations bill, specifically for state grants to address maternal mental health and the national Maternal Mental Health Hotline.

NPWH joined with other organizations in signing that letter, linked here.

Article from the AACN Journal: Built for Advocacy

The American Association of Colleges of Nursing recently published an article entitled "Built for Advocacy" in its Journal. Advocacy is a lever for positive change and is most effective and satisfying when used proactively. It is also one of nurses’ superpowers and desperately needed outside health care settings, especially in the policy arenas of local, state, and federal government. Despite nurses’ being the largest segment of the health care workforce, their voices are often missing from crucial conversations about access to care, health inequities, and upstream problems affecting people’s health. Short of being the policy makers themselves, the best way for nurses to affect these decisions is to build and use influence with policy makers. There are concrete steps that nurses can take to grab a seat at the table. Read more.

Taking Action in Support of Access to COVID-19 Vaccines

NPWH joined with other healthcare organizations on a letter in support of continued, timely access to COVID-19 vaccines.

The authors of the letter stated: "As we approach another upcoming respiratory season, we are writing to urge the FDA and CDC to continue to work efficiently and effectively together to ensure that this year, the COVID-19 vaccine is available early in the season. We very much appreciate your ongoing guidance and support and want to work together to ensure increased vaccine access and uptake in communities across the country." Read more.

Improvements Needed to Federal

Sterilization Consent Form and Process

The Coalition to Expand Contraceptive Access, with the support of NPWH and other partners, has sent a letter to the Department of Health and Human Services (HHS) to express strong and broad support for revising the federal sterilization consent form and process to better protect autonomy and increase access to care. People face multilevel barriers to accessing sterilization, stemming both from existing federal policies as well as larger issues in the healthcare system and beyond. Policies governing sterilization must be designed and examined through a reproductive justice lens, emphasizing bodily autonomy, meaningful access, and informed consent. Read more.

Supporting the Alleviating Barriers for Caregivers Act

In June, NPWH joined with AARP to sign a letter in support of the Alleviating Barriers for Caregivers (ABC) Act. Family caregivers assist their parents, spouses, siblings, grandparents, adult children, and other loved ones of all ages so they can live independently in their homes – where they want to be. Caregivers provide an estimated $600 billion in unpaid labor annually, saving taxpayers billions.

The ABC Act would help reduce red tape by requiring the Centers for Medicare & Medicaid Services (CMS) and Social Security Administration (SSA) to review eligibility determinations and application processes, procedures, forms, and communications for Medicare, Medicaid, Children’s Health Insurance Program, and the Social Security programs to reduce administrative challenges for caregivers. Read the letter here.

Supporting Recommendations on HPV Vaccines

NPWH joined HealthyWomen and the HPV Cancers Alliance are their effort to eliminate human papillomavirus (HPV)-related cancers.

In a letter drafted to President Joe Biden and Dr. Jill Biden referencing their Cancer Moonshot, the authors noted that HPV-related cancers remain an alarming public health concern in the United States, impacting nearly 40,000 Americans each year.

The HPV vaccine is extremely effective at preventing HPV infections and HPV-related cancers — preventing more than 90% of HPV-related cancers when given between the recommended ages of 9 and 12. "Even though we clearly have the tools to prevent these cancers and virtually eliminate cervical cancer, we have yet to do so. It is within our power to achieve the important Cancer Moonshot goal of preventing more cancers before they start, and one crucial step to getting there will be to reach an HPV vaccination rate that exceeds 90%," the letter stated.

NPWH signed the letter in support of their recommendations, which include:

Initiating HPV vaccination at age 9
Targeting at-risk adults ages 27-45 to be vaccinated
Ensuring compliance with affordability policies
Protecting active-duty military members and veterans, who are less likely to be vaccinated against HPV than civilians

Read the letter here.

In June, NPWH joined with the Obesity Care Advocacy Network and other organizations on a letter endorsing the U.S. House of Representatives’ Ways and Means Committee’s proposed “Amendment in the Nature of a Substitute to H.R. 4818” (AINS), supporting access to obesity treatments for Medicare beneficiaries with obesity. The AINS legislation would allow older adults to maintain their treatment for obesity without being denied access to lifesaving treatments when enrolling in Medicare. Read the letter here.

Resources for the WHNP-BC

Advocacy & Career

The National Association of Women's Health Nurse Practitioners (NPWH) is dedicated to advocating for the interests and advancement of certified Women's Health Nurse Practitioners (WHNPs) and all APRNs who provide women's and gender-related healthcare. We continuously expand resources to support certified WHNPs in their professional and advocacy endeavors.

Among these resources are comprehensive one-pagers that detail various aspects of the certified WHNP scope of practice. These documents are invaluable for advocacy efforts with organizational leaders and are instrumental in educating hiring managers and hospitals about the unique qualifications, responsibilities, and expertise of WHNP-BCs.

Our commitment to advocacy ensures that certified WHNPs are recognized and valued for their critical role in women's and gender-related healthcare, while our employment resources facilitate their career growth and professional development.

What is a Women's Health Nurse Practitioner? (updated)
Certified Women's Health Nurse Practitioners & Maternal-Fetal Medicine Specialists (updated)
Maternal Healthcare in the U.S. and the Role of the Women's Health Nurse Practitioner (new)
NPWH Clinical Position Statements
NPWH Guidelines (Women’s Health Nurse Practitioner: Guidelines for Practice and Education, 8th edition)
KFF Health Policy 101 Resource

The Advocacy Committee is currently working on a smaller scope of practice document that will be available later this summer. The NPWH Guidelines listed above is the full document detailing the education requirements for WHNP programs and practice guidelines for WHNPs. NPWH will begin drafting updates for the Guidelines for Practice and Education, and there will be an opportunity for review and third-party comments from our membership on suggested edits.

Call to Action

We have heard from our members that you are seeking action items you can do to support our advocacy efforts. Below are opportunities.

Find your members in Congress by click here.

Protect EPA's Clean Vehicle Standards

The Environmental Protection Agency recently finalized clean truck and car standards. These clean car and truck standards tackle the climate crisis, clean up our air, and protect public health. However, some members of Congress are attempting or planning to introduce legislation that could back these health-protective standards. The Congressional Review Act (CRA) is a tool Congress can use to roll back federal regulations with just a simple majority in the House and Senate. Once a rule is repealed using the CRA, the rule is void and the agency cannot issue a “substantially similar” rule again without Congressional approval. The clean car standards have massive benefits in addressing climate change and improving public health. They must remain intact as we move towards a zero-emission future. The Alliance of Nurses for Healthy Environments is calling on nurses to send a message to your representative asking them to vote against any Congressional Review Act Resolution or any other legislative mechanism that aims to roll back EPA's car and truck standards.

Help Defend Our Climate and Clean Air!

The Environmental Protection Agency recently finalized updated air pollution standards to reduce particulate matter pollution and reduce carbon emissions from power plants. These revised standards are set to have tremendous climate and health benefits. The power sector is the second-largest source of climate pollution and thus significantly contributes to the escalating and devastating impacts of climate change. Communities across the U.S. are regularly facing the consequences of climate pollution. Further, particulate matter pollution causes a range of health challenges, from worsened asthma attacks to cardiovascular and respiratory illnesses to premature death. Reducing harmful air pollution is an important step for cleaning up the air and protecting our health and well-being. Unfortunately, we are seeing efforts to overturn these two recently updated standards. The Alliance of Nurses for Healthy Environments is calling on nurses to sign on to two letters asking their members of Congress to vote against any Congressional Review Act Resolution or any other legislative mechanism that aims to roll back EPA's health-protective standards.

Nurses Improving the Environmental Health of Women & Children (NIEHWC) is a collaborative founded by NPWH & AHNE, focused on promoting women's, children's, and maternal health by reducing environmental factors contributing to health disparities and harm. This collective effort aims to bring attention, resources, and support for environmental health interventions that eliminate disparities, improve health outcomes for women and children, and promote health equity by leveraging nursing knowledge and developing and implementing equitable policy, research, education, and practice change.

In the coming months, the NIEHWC collaboration will shift to open sessions that will include NPWH members and our collaborative members. More details will be forthcoming.

AANP Federal Advocacy: Your Voice Makes a Difference!

For those who hold a joint membership with AANP, below are some take-action items. Utilize the above WHNP resources to help educate Congress about the WHNP-BC scope, education, and specialty care.

You must sign into your AANP account and with just a few clicks, your voice can make a difference when you urge your Members of Congress to: